Rejection is a normal reaction of the body to a foreign object. When a new kidney is placed in your child's body, the body sees the transplanted organ as foreign and tries to attack it.

To allow the transplanted organ to function in your child's body, your child must be given medications to block this immune response. These medications must be given to your child every day for as long as the transplant is functioning.

The following are the most common signs and symptoms of rejection. However, each child may experience symptoms differently. Symptoms may include:

• fever
• tenderness over the kidney
• elevated blood creatinine level
• high blood pressure
• decreased urine output
• weight gain

You will be given information on how to contact the transplant program if you have any questions at all about your child's condition.

Your child must take anti-rejection medications for as long as the transplant is functioning. These medications include some of the following:

• Prednisone
• Mycophenolate Mofetil
• Tacrolimus
• Cyclosporine
• Sirolimus
• Azathioprine

Typically, your child will receive two to three of these medications at a time. The doses of medications are high for the first few months after transplant, when the risk of rejection is highest. These doses are gradually reduced to "maintenance" levels by about one year after the transplant. The doses of the medications change frequently during the first year. Blood tests to measure the amount of medication in the body are performed periodically to make sure your child does not get too much or too little of the medications.

Most importantly, tests of how the kidney is functioning are performed regularly to be certain that the transplanted kidney is working normally.

Children's Hospital Boston has been on the forefront of testing new medications to prevent rejection with as few side effects as possible. Prior to the transplant we will have a detailed discussion with you to determine the best choice of anti-rejection medications for your child.

Because anti-rejection medications affect the immune system, especially in the first few months, children who receive a transplant will be at higher risk for infections. A balance must be maintained between preventing rejection and causing your child to be susceptible to infection. Your child will also receive medication to prevent infections and will have frequent tests to monitor for infection.

What type of follow-up care will my child receive?

Your child will have very close follow-up with the transplant team after leaving the hospital. These visits allow for close monitoring of your child and the function of the transplanted kidney. Follow-up visits will include:

• History
• Complete physical examination
• Blood work
• Continuing education for you and your child
• Medication changes

These visits are typically twice per week for the first two months after the transplant, and then once per week for the next two months. After that, they are generally less frequent unless a problem arises. Children who have received a kidney transplant will need life-long follow-up with physicians who are specialized in transplant medicine. At a minimum, we recommend that monthly blood tests be performed for as long as the transplant is functioning.

It is very important that you keep your appointments with the transplant team, so that monitoring will be successful.

Every child is unique and every transplant is different. On average, a living donor transplant should function for about 20 years. Results continually improve as physicians and scientists learn more about how the body deals with transplanted organs and search for ways to improve transplantation.

Living with a transplant is a life-long process. Your child will need to take anti-rejection medications and require periodic tests for as long as the transplant is functioning. Our goal is for your child to live as normal a life as possible.