The immune system is the body’s way to protect a person from things that don’t naturally belong. The immune system attacks these foreign cells in an attempt to destroy what doesn’t belong. Foreign cells may include:

• Viruses
• Bacteria
• “Foreign” tissue, such as your child’s transplanted kidney, from someone else

After transplant, the transplant team prescribes special immunosuppressant or anti-rejection medicines for your child. Without these drugs to suppress the immune system, it would probably recognize the transplanted organ as a foreign object and attack it.

The most important thing that you can do to prevent a rejection episode from occurring is to make sure your child takes her medicines every day as directed. Sometimes, a rejection episode can occur even though you and your child have done everything correctly.

During a Rejection Episode

During a rejection episode the transplant kidney may not function as well as it should. This does not necessarily mean that it will stop working completely or that your child will lose the new kidney. When recognized and treated early, it is possible to stop the rejection with little or no damage to the kidney.

In addition to taking medicine as directed, it is very important that you keep all of your child's follow-up clinic appointments so that the transplant team can detect any signs of rejection by changes in your child's physical exam or in kidney function lab tests.

Although rejection can occur without any symptoms at all, you should notify the transplant team immediately if any of the following warning signs occur:

• Fever over 100 degrees. Fever is usually a sign that the immune system is trying to fight off infection. While your child can still get a fever with colds and other types of infections, it can also be a sign of rejection.
• Other flu-like symptoms, such as chills, headache, body aches, fatigue or dizziness
• Pain or tenderness over the site of the transplanted kidney
• Sudden weight gain or swelling of hands, feet, legs or eyelids
• Difficulty breathing
• Pain or burning during urination or a noticeable decrease in the amount of urine
• Bloody urine
• Elevated blood pressure

Kidney Biopsy

In most cases where rejection is suspected, a kidney biopsy is necessary to confirm the diagnosis.

After applying numbing medicine, a needle is guided through the abdominal wall and into the kidney to remove a tiny piece of kidney tissue. By looking at the tissue under the microscope, the doctors can tell if rejection is the source of the problem.

If a biopsy is done, your child will stay in the hospital to rest in bed for at least eight to 10 hours. If a rejection episode is confirmed, we give your child a strong anti-rejection medicine (usually through an IV) for three to 10 days, depending on which medicine we use. Sometimes this may require a few additional days in the hospital.

After we treat the rejection, the treatment team may change one or more of your child’s immunosuppressant medicines to help prevent future rejection episodes. As discussed earlier, the best way for you to minimize your child’s risk for rejection is to ensure that your child:

• Takes all medicines each day as directed
• Follows the transplant team’s recommendations for follow-up visits and lab work

Infection Following Kidney Transplant

Infection is another common complication that can occur after kidney transplantation. The risk of infection is greater after transplantation because the immune system has been slowed down by the transplant immunosuppressant medicines, making it harder for your child’s body to fight infection.

This risk is greatest in the first few months after transplant, when the doses of these medicines are the highest. As these doses are reduced, your child will be less susceptible to infection since your child’s immune system will not be as suppressed.

Here are some things that our Pediatric Kidney Transplant team recommends both you and your doctor do before and after transplant to reduce your risk for infection:

Before Transplant

• Blood tests will be done to find out if your child has already been exposed to several viruses that can be a problem after transplant, such as hepatitis B and C, chicken pox, cytomegalovirus, Epstein-Barr virus (“mono”) and herpes simplex virus. We use this information to make sure your child has been immunized against as many viruses as possible before transplant. For example, your child may need to receive vaccines or booster vaccines for chicken pox and hepatitis B if these blood tests show that they don’t already have antibodies against them.
• Check with your primary care doctor to make sure that your child is up to date on all other immunizations. After the transplant, your child will not be able to receive live-virus vaccines, such as the MMR (measles, mumps and rubella). It’s best to be protected against as many viruses as possible before you start taking immunosuppressant medicines.
• Visit your child’s dentist for a checkup to check for any problems that could cause infection, such as cavities or abscesses.
• Make sure your child stays as healthy as possible before the transplant. Follow the doctor’s instructions for dialysis, diet and medicines. Your child will recover and heal more quickly and be less susceptible to infection after the transplant if they are in good shape

After Transplant

• Since your child will be at the highest risk for infection in the first four to six weeks after transplant, there will be some restrictions during that period, such as avoiding crowded, enclosed places where there are lots of germs, such as at malls or movie theatres. Your child may also be asked to wear a mask when he returns to the hospital for their follow-up clinic visits to protect them from the germs inside the hospital. Your child will not have to wear a mask outside.
• Your child should avoid being around people who are visibly ill, should never share eating utensils or cups and should wash their hands frequently.
• Your child will take some medicines for the first few months after transplant to help protect against bacterial, viral and fungal infections.
• Notify the transplant team immediately if your child has any symptoms of infection such as fever, chills, rash, cough, vomiting, diarrhea or pain when they urinate. Whenever in doubt, it’s always safer to call us to discuss your concerns.

Other Complications

Hypertension (High Blood Pressure)

Hypertension is common after kidney transplant as it is a side effect of some of the immunosuppressant medicines that your child will be taking. The Pediatric Kidney Transplant Program team will monitor blood pressure very carefully at your child’s follow-up visits, and it is likely that your child will need to take one or more blood pressure medicines.

Medication Side Effects

Most other post-transplant complications are related to side effects of immunosuppressant medicines and may necessitate additional medicines to treat them if they occur, including:

• Hypertension
• Diabetes
• Osteoporosis
• Hyperlipidemia (high cholesterol and triglyceride)

Developing medication side effects, and at what doses, depends on your child’s genetic makeup and on other partially unknown factors, including chance.