After Kidney Transplant

Organ rejection is a specific problem that can occur after transplant surgery. The new kidney comes from another person, so your child’s immune system will recognize that the kidney is different and may try to attack it. If your child’s immune system injures the kidney, this is called rejection.

The possibility for rejection is greatest soon after transplant. But at any point your child’s immune system might try to reject the kidney.

For the new organ to work successfully in your child’s body, we must give your child medicines that suppress the immune response. To prevent rejection, your child may need to take medicines for as long as the kidney is in place.

Rejection does not necessarily mean that your child will lose the kidney. If detected early, most rejection episodes can be treated successfully.

There are 4 types of organ rejection.

• Acute rejection

  Acute rejection usually occurs within the first 6 months after transplant surgery. During that time, we will regularly draw blood from your child to monitor the level of creatinine, a protein released into the blood as waste from the muscles. Higher levels of creatinine in your child’s blood may mean the kidney is not doing a good job flushing waste out of your child’s body.

  We confirm that this is what is happening by performing a biopsy – it is a procedure where we insert a needle into your child’s kidney and take a tiny sample of tissue. Looking at the tissue under a microscope, we will be able to see if your child’s immune system is causing injury to the kidney. Your child will be asleep for this procedure and might need to stay in the hospital overnight afterwards.

  It is common to see at least 1 rejection episode about 2 to 3 months after surgery. Do not get discouraged. This is why we check your child so closely with lab work and other tests.

• Subclinical rejection

  Subclinical rejection is where very early rejection is detected with a kidney biopsy before there is enough damage to cause the creatinine in your child’s blood to increase. Early treatment for this condition can improve your child’s chance of keeping the new kidney for longer. To detect this, we do a needle biopsy of the kidney 3 different times: between 3-6 months, at 1 year and and at 2 years following transplant.

  If acute or subclinical rejection is diagnosed, we will start antirejection medicines. Usually we start with a high dose of prednisone, which is a steroid that helps suppress the immune system so that your child’s body will not reject the kidney. The prednisone is given through an IV for 3 days. If prednisone does not work, other medicines can be used.

• Chronic rejection

  Chronic rejection occurs slowly over time. The kidney develops scar tissue from the immune system causing injury to the kidney over a long time.

  Chronic rejection can be more difficult to reverse. It can lead to decreased kidney function. Our care focuses on maintaining kidney function for as long as possible. Eventually your child might need to go back on dialysis or get another transplant

• Hyperacute rejection

  Hyperacute rejection occurs right after the blood supply is connected to the new kidney in surgery. This type of rejection rarely happens because the crossmatch test prior to surgery usually identifies antibodies that would cause this type of reaction.

During the first year after the transplantation, your child will need to visit the Nephrology Clinic many times for follow-up visits and lab tests. To schedule appointments, contact the Nephrology Clinic.

• Typical schedule

  A typical schedule of post-transplant clinic visits and lab tests might be: 

  • Day 1 to 30 after surgery:
    • Clinic visits 2 times a week
    • Lab tests 2 times a week
  • Day 31 to 90 after surgery:
    • Clinic visits 1 time a week
    • Lab tests 2 times a week
  • Day 91 to 210 after surgery:
    • Clinic visits 2 times a month
    • Lab tests 1 time a week
  • After day 210:
    • Clinic visits 1 time a month
    • Lab tests 1 time a month 

  These are general guidelines. If your child is doing well, clinic visits and lab tests may be less frequent. If your child is having complications, visits may be more frequent.

• Things to remember
  • We must be able to contact you at any time. We need to have current mobile, work and home phone numbers.
  • Your child will need lifelong medical and transplant follow-up – throughout childhood and into adulthood – to ensure the best kidney function. We will continue to check for any transplant-related problems.
  • Your child’s transplant nurse coordinator or transplant nurse practitioner will act as your main contact at Seattle Children’s for any problems or questions.