Kidney Transplant

Kidney transplant evaluation

During your child's evaluation for a kidney transplant:

• The transplant coordinator arranges a series of tests to assess your child's treatment options.
• The transplant staff discusses any medical problems that need to be evaluated before the transplant, such as heart disease, infections, bladder issues, ulcer disease or obesity.
• A social worker meets with you to assess your transportation, housing, financial and family support needs.
• A financial counselor meets with you to ensure you understand your insurance policy's covered benefits.

We encourage you to ask questions and learn as much as possible about the transplant process before making a decision.

Screening tests

Special blood tests are necessary to match your child with a suitable donor.

Blood type

The first test determines your child's blood type. There are four: A, B, AB and 0. A transplant recipient and donor must have the same blood type or compatible types. Otherwise, the recipient's body would recognize the donor kidney as "foreign" and destroy it.

• If your child's blood type is A, the donor's blood type must be A or O
• If your child's blood type is B, the donor's blood type must be B or O
• If your child's blood type is AB (universal recipient), the donor's blood type may be A, B, AB or O
• If your child's blood type is O (universal donor), the donor's blood type must be O

Patients with AB blood type are the easiest to match because they accept all other blood types. Blood type O is the hardest to match. Although people with blood type O can donate to all types, they can receive kidneys only from blood type O donors.

The Rh type (+, -) is not a factor in donor matching.

Human leukocyte antigens (HLA)

The second test is HLA typing, also called tissue typing. Human leukocyte antigens are 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.

All potential donors, whether or not they're related to your child, can arrange to have the tissue typing test. No special preparation is required and results are available within two weeks. Pre-packaged kits with instructions on how to collect and return blood samples are available to mail to potential donors who don't live nearby. Blood can be drawn at a local doctor's office or hospital laboratory and sent to the UCSF Transplant Service via overnight mail.

Crossmatch

The immune system makes proteins called antibodies, which attack foreign substances such as bacteria and viruses. We may make antibodies when we have an infection, have a blood transfusion or undergo a kidney transplant. If your child has antibodies to the donor kidney, their body will destroy the kidney. To ensure that your child doesn't already have antibodies to a potential donor, we perform a test called a crossmatch.

To perform a crossmatch, we mix your child's blood with cells from the donor. If the crossmatch is positive, it means that your child has antibodies against the donor and should not receive a kidney from this person. If the crossmatch is negative, your child doesn't have antibodies to the donor and is eligible to receive this kidney.

Crossmatches are performed several times while preparing for a living-related donor transplant, particularly if donor-specific blood transfusions are used. A final crossmatch is performed within 48 hours before the transplant.

Serology

We test for potentially transmissible diseases, such as HIV (human immunodeficiency virus), hepatitis and CMV (cytomegalovirus).

Once your child's evaluation is complete, the transplant team meets and decides if your child is a candidate for transplant. This decision is made only after discussing the case with the nephrologist (kidney specialist), surgeon, transplant coordinator, social worker and financial counselor. If a transplant isn't in your child's best interest, a transplant team member will call and discuss other options with you.

Living donor transplants

It's possible for a living person to donate a kidney. After the donor's surgery, the remaining kidney enlarges and performs the work of two kidneys. As with any major operation, there's a chance of complications, but living kidney donors have the same life expectancy, general health and kidney function as most other people.

Potential living donors meet with a transplant surgeon and a transplant coordinator during the evaluation process to discuss the possibility of organ donation. We perform tissue typing and other tests to determine if the potential donor is suitable. In some families, several people are suitable donors; in others, no suitable living donors are found.

To learn more about the evaluation and transplant process for living donors, visit Living Donor Kidney Transplant.

Deceased donor transplants

The Uniform Anatomical Gift Act allows people to donate organs for transplant when they die and allows their families to provide permission as well. All donors are carefully screened to prevent disease transmission. After permission for donation is granted, the donor's kidneys are removed and stored until a recipient is chosen.

Waiting for a donor kidney

If your family and the medical team decide that a transplant from a deceased donor is your child's best option, your child will be placed on a national transplant waiting list. They will have monthly blood tests to check their antibody levels. The length of the waiting period depends on the availability of a cadaver donor compatible with your child's blood type and antibody level.

When a kidney becomes available, your child's referring kidney specialist is contacted for medical approval. UCSF's transplant service will verify that your child hasn't had any recent infections or medical problems that would interfere with a safe transplant. We will tell you when a cadaver kidney becomes available and will help you make transportation arrangements if needed.

Kidney transplant surgery

A kidney transplant takes two to four hours. During the operation, the transplanted kidney is placed in the pelvis rather than the usual location in the back. (Your child's own kidney won't be removed.) The artery that carries blood to the kidney and the vein that carries blood out of it are surgically connected to two blood vessels in the pelvis. The ureter, the tube that carries urine from the kidney to the bladder, is transplanted through an incision in the bladder.

After the operation, your child is taken to the recovery room for a few hours, then returned to the Kidney Transplant Unit. The surgeon will let you know when the procedure is over.

We'll encourage your child to get out of bed 12 to 24 hours after surgery to walk around the unit. Before discharging your child from the hospital, nurses will discuss post-transplant medications and their side effects, as well as nutrition guidelines after transplant, with your family.

A cadaver kidney may be temporarily slow in functioning, a condition called "sleepy kidney" or acute tubular necrosis. A sleepy kidney usually starts working in two to four weeks. Until then, your child may need dialysis a few times. This won't harm the kidney.