Pediatric Kidney Transplantation Workup

Updated: May 22, 2018
  • Author: David Hatch, MD; Chief Editor: Stuart M Greenstein, MD  more...
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Laboratory Studies

The following studies are indicated in kidney transplantation candidates:

In PRA testing, recipient serum is incubated with white blood cells pooled from a group of blood donors with human leukocyte antigen (HLA) types representative of the community. Cell kill indicates that the recipient has antibodies against the donor cells. The percentage of the donors against which the recipient reacts is used as a predictor of the likelihood of a positive cross-match that would prevent transplantation.

Viral titers include the following:

Children who demonstrate no antibody to CMV, VZV, and EBV are at increased risk of posttransplant primary infection, especially if they receive kidneys from donors who are seropositive for these viruses.

Closely monitor such recipients following transplantation and provide appropriate antiviral therapy (agents that prevent viral proliferation or antibodies directed against a specific virus). Ensure that all children are immunized against HBV prior to transplantation. See Pediatric Hepatitis B for complete information on this topic.


Imaging Studies

Imaging studies include chest radiography and abdominal ultrasonography. Additional studies depend on the child's urologic pattern, as revealed by a thorough medical history. A history of congenital urologic anomaly, recurrent urine infections, and/or voiding abnormalities (eg, incontinence, frequency, urgency) identifies children who should undergo further urologic imaging or evaluation, including voiding cystourethrography and possible urodynamic studies.


Urodynamic Evaluation

Urodynamic evaluation should be performed in children with a history of voiding dysfunction (eg, incontinence) or major reconstruction of the lower urinary tract. A urodynamic study is a functional evaluation of the bladder that measures the following:

  • Bladder capacity
  • Bladder storage pressures
  • Voiding function and pressure
  • Coordination of the components of the lower urinary tract

If low bladder capacity, high storage pressure, incomplete emptying, or high voiding pressure is found on urodynamic testing, instituting intervention prior to transplantation to prevent urine infection, urinary obstruction, or incontinence may be appropriate.