Preparing for a kidney transplant

Transplant team

Your transplant team will support you and your child before, during and after transplantation.

  • Transplant nurse (or coordinator): a nurse who is experienced in kidney transplants in children, will give information and support before, during and after your child’s transplant.
  • Paediatric nephrologist: your child will continue to be looked after by the paediatric nephrologist, a doctor who treats babies, children and young people with kidney problems, and may be in a hospital or clinic.
  • Transplant surgeon: you will have the opportunity to meet with the transplant surgeon, who manages the operation, before and on the day of transplantation.
  • Play specialist: your child can meet with a play specialist, a professional who uses dolls and other toys to help your child prepare for the tests and operation.
  • Renal psychologist or counsellor: you and/ or your child may meet with a renal psychologist or counsellor, who supports you and your family, especially with emotional stresses and strains of looking after a child with kidney disease.
  • Renal social worker: a professional who supports you and your family, especially with any concerns about money, travel and housing related to looking after your child with kidney disease.
  • Paediatric dietitian: a professional who advises what your child should eat and drink during different stages of a kidney condition 

Tests 

Your child will need many tests to make sure he or she is ready for a transplantation. These include a series of blood tests, as well as some imaging tests (scans), especially to check that his or her heart and blood vessels are healthy. Sometimes other tests are needed. These tests often start during stage 4 CKD when your child is preparing for treatment for established renal failure. Your child will need to continue going back to the unit for further tests while he or she waits for the transplant – sometimes up to a year or longer.

Blood tests

Your child will need a series of blood tests. A small amount of blood will be taken from a vein, using a needle and syringe. A special gel or cream can be used to help your child stop feeling any pain.

These give information about the following.

  • Blood group and tissue typing – as described in Matching.
  • Serology – this test checks whether your child has immunity to certain diseases, which means they will usually not get ill again with these diseases. The first time we are infected with a particular virus, which causes a disease, our body’s immune system makes antibodies to fight it. The next time we are infected with the virus, our body can fight it more quickly so we do not get ill. For transplants, blood tests check for immunity to the following: measles, mumps, rubella, chicken pox (varicella), CMV, EBV, hepatitis B, hepatitis C and HIV.
  • HLA-tissue-type and antibodies

Imaging tests

Your child will need some imaging tests (scans). These use special equipment to get images (pictures) of the inside of his or her body. 

  • Ultrasound scan – looks at the shape and size of the kidneys and other parts of the urinary system. A small handheld device is moved around your child’s skin and uses sound waves to create an image on a screen. An ultrasound scan may also be used to check the blood vessels in your child’s neck, abdomen (tummy area) and groin to make sure that the blood is flowing through them correctly.
  • Echocardiogram (ECHO) – looks at the heart, also using ultrasound.

Occasionally, other imaging tests are needed.

Electrocardiogram

An electrocardiogram checks whether your child’s heart is working well, or whether there are any problems with his or her heartbeat. Sticky pads are placed on your child’s chest, and a machine measures the normal electrical activity.

Urodynamics

If your child has a history of bladder problems or vesicoureteral reflux (VUR), he or she may also need urodynamics. These tests check how well the bladder is working.

Vaccines

It is important that your child has vaccinations (immunisations) against certain diseases. These include all the normal childhood vaccines plus chicken pox – if he or she has not already had this illness – hepatitis B and sometimes BCG (for TB). Your child’s doctor will need to check that he or she has developed antibodies against many of these infections, particularly:

  • measles
  • rubella
  • chicken pox
  • hepatitis B.

Live vaccinations must be completed at least one month before transplantation, or three months for the BCG vaccine.

Coming to hospital

You will be told when your child needs to come to the hospital – this depends on whether your child will have a live donor or deceased donor transplant. As your child will be at the hospital for some time, you should bring clothes, toiletries, toys and books. You can speak with the transplant team about any arrangements for you and your family to stay at or near the hospital.

Some children will need dialysis just before the transplant, on the basis of the blood tests (read more below). 

Tests on the day of transplant

Some tests need to be done on the day of the transplant itself. Your unit may not be able to go ahead with the operation if your child is ill – for example, with a cold or fever. Children need to start taking immunosuppressant medicines before the operation, and because these make the immune system less active, your child would be less able to fight the illness.

Blood tests

More samples of your child’s blood will be taken for the following. 

  • Blood clotting – this test is used to find out whether the blood is clotting properly. Clots form in the blood to heal a wound, such as a cut in the skin, and it is important to know that your child’s blood will clot as expected after the surgery.
  • Electrolytes – to check the blood potassium is not too high and to check the acidity of the blood.
  • Serology – this test, which checks for immunity to illnesses, is repeated.
  • Group and save – a small sample of your child’s blood is stored to be used in the rare event that your child needs a blood transfusion (if they have heavy bleeding). The hospital will be able to find out your child’s blood group, so that they can get the right type of blood from a donor.

Read more about electrolytes

Electrolytes are important chemicals in the body. We need the right balance of these to stay healthy. Some important electrolytes include the following:

  • sodium helps balance the amount of water in the body
  • potassium is needed for the muscles, including the heart muscle, to work properly
  • bicarbonate balances the amount of acid in our body, or the pH balance (also called the acid–base balance)
  • phosphate is important for bones, teeth and muscles
  • calcium is important for bones and teeth, helps blood to clot and also helps the muscles, including the heart muscle, to work.