If it seems like it’s the right time for your child to have a kidney transplant, we’ll ask you to come to the hospital for an informational visit. Your family will meet our transplant team, and you’ll be invited to ask questions and share any concerns you may have. We encourage you to bring family to this initial meeting.
If you and the transplant team agree that a kidney transplant is a good idea, your child will be scheduled for an extensive array of tests that are necessary to:
- confirm that a transplant is the appropriate treatment
- determine how urgent the need for a transplant is
- make sure that the donor kidney your child receives will be a good match
Who will we meet with during the transplant evaluation?
A transplant is a complex procedure that touches different medical specialties – that’s why you and your child will meet and work with Children’s Hospital Boston experts from a number of different areas, including:
Kidney transplant surgeon: surgeons who specialize in transplantation and who will be performing your child’s surgery. They follow your child before the transplant and continue to follow her after the transplant and after discharge from the hospital.
Transplant nephrologists doctors who specialize in disorders of the kidneys. They will help manage your child’s condition before and after the surgery.
Urologists: surgeons who specialize in disorders of the genitourinary tract
Kidney transplant nurse coordinator: a nurse who organizes all aspects of care provided to your child before and after the transplant. The nurse coordinator will provide information for you and your family, and coordinate the diagnostic testing and follow-up care.
Transplant infectious disease specialist: a clinician who will perform a physical exam and review your child's vaccination records. We will want to know if your child has any particular environmental exposures or has recently traveled to a foreign country.
Transplant psychiatrist or psychologist: doctors who will meet with you and your child to discuss coping strategies, stress management and family life.
Social worker: a specialist who will meet with you and your family to identify support systems and discuss your feelings about transplant. He or she can provide you with information about resources related to finances, relocation expenses and support groups.
Transplant dietician: our registered dietician will evaluate your child's diet and nutritional requirements. Maintaining a healthy lifestyle and good nutrition before the transplant is very important.
Transplant pharmacologist: a specialist who makes sure that your child is getting the exact right dosages of the medication she has been prescribed.
Physical therapist: a specialist who will discuss the importance of exercising before transplant in a way that is appropriate for your child.
- Dentist: your child will meet with her own dentist or one here at the hospital. The goal is to treat any cavities, infections or tooth abscesses before transplant, since these conditions can be problematic once your child begins to take medicine to suppress his immune system.
Other members of your child’s transplant team may include:
- transplant Child Life specialists
- respiratory therapists
- lab technicians
Children’s is also home to one of the two pediatric kidney transplant training programs in the country. Your child is in good hands with us.
What tests are done during the evaluation?
Your child’s transplant team will order different tests to rule out infections, see how well her organs are functioning, and make sure a donor match is compatible. These types of tests may include:
1. Blood tests
- blood type – Your child and the donor must be of compatible blood types.
- clotting studies, such as prothrombin time (PT) and partial thromboplastin time (PTT) – tests that measure the time it takes for blood to clot
- blood chemistries – These may include serum creatinine, electrolytes (such as sodium and potassium), cholesterol, and liver function tests.
- antigens and antibodies – These tests help determine how likely it is that a transplant will be successful by checking the genetic types of your child's cells as well as the antibodies in your child's blood.
Other tests will check for exposure to viruses, bacteria and infections including:
- hepatitis A, B and C
- cytomegalovirus (CMV)
- Epstein Barr virus (EBV)
- herpes simplex virus (HSV)
- tuberculosis (TB)
3. Other kinds of tests
- renal ultrasound – a non-invasive test in which a transducer that produces sound waves is passed over your child’s kidney
- cystourethrogram (VCUG) – an x-ray of your child’s bladder after the clinician has injected contrast dye into it. This study is performed to identify any problems that might interfere with the functioning of the new kidney.
The transplant team will consider all information from interviews, your child's medical history, physical examination and diagnostic tests in determining whether your child has reached a level of end stage renal disease that requires a kidney transplant. They may also decide that some additional studies or procedures are necessary before the transplant to ensure its chance of success.
Once your child has been fully prepared to have a kidney transplant, the transplant will be scheduled if there is a qualified living donor. If there is no living donor, your child will be placed on the United Network for Organ Sharing (UNOS) list.
|Child Life specialists|
|"Don't forget to tell them the rules," 7-year-old Lia DiFronzo says to Amber Soulvie, her Child Life specialist. Read more about how our Child Life specialists help children like Lia.|
|The Experience Journal|
|Designed by Children’s psychiatrist-in-chief David DeMaso, MD and members of his team, the Experience Journal is an online collection of thoughts, reflections and advice from kids, parents and other caregivers about the transplant experience.|
|Keep family and friends up to date during your child’s treatment by creating a free Children’s CarePage.|