Pediatric Kidney Transplantation Workup

Updated: Sep 18, 2020
  • Author: Rekha Agrawal, MD; Chief Editor: Stuart M Greenstein, MD  more...
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Workup

Laboratory Studies

The following studies are indicated in kidney transplantation candidates:

  • Complete blood cell count (CBC)
  • Comprehensive metabolic panel, plus serum phosphorus and magnesium
  • Parathyroid hormone
  • Liver function tests
  • Coagulation studies - These should include prothrombin time with International Normalized Ratio (INR) and activated partial thromboplastin time
  • Human leukocyte antigen (HLA) and panel reactive antibody (PRA) testing
  • Viral titers

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.

One must therefore closely monitor such recipients following transplantation and provide appropriate antiviral therapy (agents that prevent viral proliferation or antibodies directed against a specific virus). One should ensure that all children receive routine childhood immunizations, including pneumococcal 13-valent conjugate vaccine and hepatitis B vaccine. In addition, children age 2 years and older should also receive the 23-valent pneumococcal vaccine, given at least 8 weeks after the child has received the final dose of the 13-valent vaccine. All live vaccines should be given at least 2 months prior to transplantation. See Pediatric Hepatitis B for complete information on this topic.

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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 and cystoscopy.

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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.

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