Kidney Transplant

Pediatric Kidney Transplant

Signs and Symptoms
Evaluation
Treatment

Evaluation

During the evaluation, a transplant coordinator will arrange for a series of tests to assess your child's treatment options. The transplant staff also will discuss any medical problems that need to be evaluated before the transplant, such as heart disease, infections, bladder dysfunction, ulcer disease or obesity. The social worker will meet with you to assess transportation, housing, financial and family support needs. A financial counselor will meet with you to ensure you understand the covered benefits of your insurance policy. You will have an opportunity to ask questions. We encourage you to learn as much as possible about the transplant process before making a decision. It's not necessary for you to reach a decision by the end of the session.

Screening Tests

Regardless of the type of kidney transplant your child may undergo - living or cadaveric - special blood tests are needed to determine his or her kind of blood and tissue.

These test results help to match a donor kidney to your child's body.

Blood Type Testing

The first test establishes your child's ABO blood type. There are four blood types: A, B, AB, and 0, and everyone fits into one of these inherited groups. The recipient and donor must have either the same blood type or compatible ones. The list below shows compatible types.

• If your child's blood type is: A
  The donor blood type must be: A or O

• If your child's blood type is: B
  The donor blood type must be: B or O

• It your child's blood type is: AB (universal recipient)
  The donor blood type must be: A, B, AB, or O

• If your child's blood type is: O (universal donor)
  The donor blood type must be: O

As indicated, the AB blood type, called the universal recipient, is the easiest to match because that individual accepts all other blood types. Blood type 0, called the universal donor, is the hardest to match. Although people with blood type O can donate to all types, they can receive kidneys only from blood type 0 donors. For example, if a patient with blood type O were transplanted with a kidney from an A donor, the body would recognize the donor kidney as foreign and destroy it. The Rh type (+, -) is not a factor in donor matching.

Human Leukocyte Antigens (HLA)

The second test, which is a blood test for human leukocyte antigens (HLA), is called tissue typing. These antigens are substances found on many cells of the body, but are mostly seen on white blood cells. Tissue type likeness between family members may be 100, 50 or 0 percent. The tissue type of all potential donors is considered in donor selection.

The prospective recipient and all interested family members and non-relatives can make arrangements with the transplant team for tissue typing. No special preparation is required and results are available within two weeks. Pre-packaged kits with specific instructions about how to collect and return blood samples are available to mail to out-of-town relatives. The necessary blood can be drawn at a local physician's office or hospital laboratory and sent back to us via overnight mail.

Crossmatch

Throughout your child's life, his or her body makes substances called antibodies that destroy foreign materials. He or she may make antibodies each time he or she has an infection, has a blood transfusion or undergoes a kidney transplant. If your child has antibodies to the donor kidney, the kidney will be destroyed. For this reason, we conduct a test to insure that your child doesn't already have antibodies to the donor when a donor kidney is available. This test is called a crossmatch.

The crossmatch is done by mixing your child's blood with cells from your donor. If the crossmatch is positive, it means that your child has antibodies against the donor and should not receive this particular kidney. lf the crossmatch is negative, it means your child doesn't have antibodies to the donor and is eligible to receive this kidney. Crossmatches are obtained several times during preparation for a living-related donor transplant, particularly if donor-specific blood transfusions are used. A final crossmatch also is performed within 48 hours before the transplant.

Serology

Testing is done for potentially transmissible diseases, such as HIV (human immunodeficiency virus), hepatitis, and CMV (cytomegalovirus).

Transplant Waiting List Placement

Once the evaluation is complete, the transplant team will meet and a decision is made whether or not to place your child on the transplant waiting list. This decision is made only after discussing each case with the nephrologist, surgeon, transplant coordinator, social worker and financial counselor. You will be notified when your child's name is placed on the UNOS national transplant waiting list.

If a transplant isn't in your child's best interest, a transplant team member will call and discuss other options with you.

Reviewed by health care specialists at UCSF Children's Hospital.
Last updated May 8, 2007