Follow-up visits  

At home

Blood test results

Healing after surgery

Future dental work

Transplant medicines

Possible complications after transplant

Check your child's vital signs regularly

Normal laboratory values

Follow-up visits
Your child will need to return to The Transplant Center within one week of surgery. At that time, the surgeon will check your child's incision and test results. Your child will also see the nephrologist (kidney doctor) and transplant coordinator.

You must bring your child's medicine card and patient handbook to this visit. We will tell you about your child's future visits at that time.

At home
If your home is far from the Twin Cities, your care team will tell you when your child is ready to move back home. You and your child may need to stay near the Transplant Center for a short time after leaving the hospital. After your child goes home, he or she must see your child's kidney doctor (nephrologist) regularly. The doctor will have all the details from your child's transplant. Your child should also see your family doctor for a yearly exam.

A home health nurse may come to visit your child for the first couple of weeks at home. The nurse will help with routine blood tests, check your child's incision for infection, change bandages, review your child's medicines and provide other care. If you have any questions, please call your child's transplant coordinator.

Blood test results
When your child first goes home, he or she will need to have blood tests three times a week. This will decrease over time. Your child will need blood tests for the rest of his or her life.  This will tell us how well your child's kidney is working. Just because your child feels well does not mean that your child's kidney is healthy. If your child's body rejects the kidney, there may be no symptoms.

You will need to write your child's lab results in the log book and call them in to the transplant office. The transplant coordinator will call you if there are changes or concerns. If you do not give us your child's lab results, we will not know if your child's kidney is working well.

Healing after surgery
Your child's energy level will be low when he or she first returns home. Keep in mind that your child just went through a major surgery and will need time to recover. It may take three to six months before your child starts to feel normal again.
Please remember:

• Your child should not lift anything heavier that 10 pounds for at least six weeks after returning home.
• Your child may not feel like eating much. Encourage your child to eat small meals and snacks throughout the day to maintain his or her weight.
• Some people have problems sleeping. If your child needs to take a nap in the afternoon, allow him or her to do so. Your child's energy will improve with time.
  

Future dental work
After your child's transplant, try to wait at least six months before taking your child to the dentist. Your child will need to take antibiotic (germ-fighting) medicine before every dental visit.

Transplant medicines
After your child's transplant, his or her immune system will see the new kidney as something foreign. It may attack the kidney, causing your child's body to reject it. To prevent or control rejection, your child must take anti-rejection drugs (immunosuppressive medicines) for the rest of his or her life. If not, your child will lose the kidney and get very sick. He or she may even die.

Possible side effects are listed with the drugs that follow. Your child may have more side effects right after the transplant, but these will often go away over time. We will adjust your child's medicines based on his or her regular lab tests. In this way, we strive to reduce side effects while preventing rejection.

Your child will take up to three anti-rejection drugs by mouth every day. Your child's transplant doctors will tell you which drugs are best for your child. They will explain the side effects and tell you how to manage them. Your child's anti-rejection drugs may include:

• Cyclosporine A (CSA; Neoral, Gengraf) or tacrolimus (FK506; Prograf): You will need
  regular blood tests to check the level of medicine in your child's blood. Blood levels that are too high can cause side effects such as hand tremors, tingling or headache, high blood pressure, high potassium, high blood sugar or increased hair growth. Long-term use of this medicine can cause kidney problems. Your child's doctor will watch for this.
• Azathioprine (AZA; Imuran): At first, AZA may cause your child's hair to thin. It can also decrease your child's white blood cell count. We may need to adjust your child's dose to maintain the right white blood cell count.
• Mycophenolate mofetil (MMF; CellCept): MMF may cause diarrhea (loose, watery stools), nausea (upset stomach) and vomiting (throwing up). It may also decrease your child's white blood cell or platelet count.
• Sirolimus (Rapamune, rapamycin): This may raise your child's cholesterol and triglycerides (blood fats). It may also decrease your child's white blood cell or platelet counts. Some people have mouth sores, muscle pain or diarrhea.
• Prednisone: In high doses, prednisone can cause slow healing. It can also cause increased appetite, weight gain, stomach irritation or ulcers, bloating, high blood sugar, bone and joint problems, sleeping problems, mood swings and depression. Most people do not take prednisone after leaving the hospital.

Your child's anti-rejection drugs may reduce the ability of your child's body to fight infections. If your child becomes ill, he or she may be sick longer than normal. To prevent some of the most common serious infections, your child must also take:

• An anti-fungal medicine for three to six months (nystatin, Mycelex)
• An anti-viral medicine for three to six months (vlagan-ciclover, acyclovir, ganciclovir)
• An antibiotic for the rest of your life (Bactrim, Septra).

Your child's doctor may also give him or her medicine to control blood pressure and stomach acid. Both of these may be a problem after transplant.

Possible complications after transplant
While some problems might appear right after surgery, others may show up weeks, months and even years later. Most of the time your child's local doctor can treat any problems that occur. In some cases, your child may need to return to the Transplant Center.

Surgical problems
Surgical problems, though rare, may occur during or right after surgery. They include:

Bleeding

• Kinked or narrow blood vessels
• A lymphocele (a build-up of fluid)

These problems require treatment. They may lead to a longer stay in the hospital.

Blockage in your child's urinary system
If your child's urine is blocked from leaving the body, your child may have a nephrostomy tube. This is a tube that drains urine from your chidl's kidneys. Your child may have a tube for several weeks or months. Your child's surgeon will tell you when it should come out.

Infection
Call your child's doctor if you see any signs of infection such as:

• Fever over 101°F (38.3°C) (under the tongue), with or without chills
• High white blood cell count
• Pain or redness at the incision or drain site
• Cold or flu symptoms

Most infections can be treated with medicine from your child's kidney doctor or family doctor.  For severe infections, your child may need to return to the Transplant Center.

Rejection
A rejection may occur at any time. It is most likely to occur in the first three to six months after transplant. Your child may have no symptoms if a rejection begins. It is found with blood tests. Your child must have blood tests three times a week for the first month after transplant. In time, your child will need blood tests less often: about once a month for the rest of his or her life.

Your child may have the blood tests at your local clinic. Have the clinic fax us your child's test results. If you don’t, we will not know that your child is having a rejection.

If your child is having a rejection, it is vital to catch it early. This improves the chances that the problem can be treated. We will adjust your chid's medicines. Your child may need to come to The Transplant Center. The risk of rejection lessens with time, but it never goes away. As this risk decreases, so will your child's doses of anti-rejection medicines. As your child's medicines decrease, most of the side effects will get better as well.

If your child ever stops taking his or her medicines, your child's body will reject the new kidney. Your child will lose the kidney, become very sick, and may even die.

High blood pressure
This is very common. It is more likely to occur in the first three months after surgery. Your child's doctors will use medicine to treat blood pressure.

Blood in the urine (hematuria)
The color of your child's urine may range from pink to bright red. Your child may also have blood clots in the urine. This may be due to infection, rejection or the stitches used during surgery.

Diabetes
The medicines your child is taking may cause diabetes. If this happens, your child will have to watch his or her diet and test blood sugar often. Your child may need insulin shots.

Cancer
Taken over many years, your child's anti-rejection drugs may increase his or her risk of cancer, especially skin cancer. For this reason, your child should cover up before going out in the sun or use a sun block (at least SPF 15). Do not allow your child to use tanning beds.

Your child's anti-rejection medicines may also increase his or her risk of lymphoma, a more serious form of cancer. Your child should see your doctor for a yearly exam.

Return of your kidney disease
Several types of diseases can come back after a transplant, including:

• MPGN (membranoproliferative glomerulosclerosis)
• FSGS (focal segmental glomerulosclerosis)

Please discuss and concerns with your child's transplant surgeon.

Check your child's vital signs regularly
You will need to check your child's vital signs regularly, both before and after the transplant. You should have the following items at home:

• A thermometer to check your child's temperature. A high temperature or a fever can be sign of infection. After your child's kidney transplant, it may also signal rejection.
• A scale to check your child's weight. Your child's weight may go up or down a little each day based on fluid changes in the body. This may occur months or years after transplant. You may also find that your child has a better than average appetite. It is important to help him or her avoid gaining too much weight.
• A blood pressure cuff. Many things affect blood pressure, including hormones, medicines, fluid in the body and how well your child's kidneys are working. Your child's family doctor or kidney doctor (nephrologist) will help you manage your child's blood pressure after the transplant. Please see your child's family doctor soon after your child leaves the hospital. Return once a year for a check-up.

Normal lab test values
For most blood tests, “normal values” vary from one lab to another due to different testing methods. The values listed here are current at University of Minnesota Medical Center since 2001. Some values are “off” or abnormal for persons with kidney disease.

You will get to know your child's own normal values, close to these ranges, after the transplant. For a few tests, normal values have not been established.

Hematology blood tests
Hgb (hemoglobin)..................11.5 to 15.7 g/dl
Hct (hematocrit).....................35% to 45%
WBC (white blood count).......4 to 11 x 103/mm3
Platelets...................................150 to 450 x 103/mm3
Liver function tests
AST........................................0 to 45 u/1
ALT........................................0 to 45 u/l
Alk p’tase
(alkaline phosphatase)..........130 to 530 u/1
Bilirubin direct (conjugated)....0.0 to 0.4 mg/dl
Bilirubin total.........................0.0 to 1.3 mg/dl
5’ Nuc....................................0 to 12.0 u/l

Electrolytes and blood chemistries
Na (sodium)...........................133 to 143 mmol/1
K (potassium).........................3.4 to 5.5 mmol/1
C1 (chloride)..........................96 to 110 mmol/1
HC03 (bicarbonate)...............20 to 32 mEq/1
BS (glucose)............................60 to 115 mg/l00m1
BUN (blood urea nitrogen)....5 to 24 mg/dl
Cr (creatinine)........................0.4 to 1.0 mg/dl
Ca (calcium)...........................8.7 to 10.8 mg/dl
Phos (phosphorus)..................2.9 to 5.4 mg/dl
Mg (magnesium)....................1.6 to 2.3 mg/dl
Coagulation tests
PT..........................................11.0 to 13.5 sec
PTT........................................23.0 to 34.0 sec
TT..........................................13.0 to 18.0 sec
INR........................................0.89 to 1.09
Factor V..................................70 to 130%
Fibrinogen..............................170 to 370 mg/dl
Blood gases
pH..........................................7.35 to 7.45
p02.........................................85 to 105 mmHg
PC02......................................26 to 40 mmHg
HC03.....................................18 to 29 mmol/L
Other tests
Albumin.................................3.3 to 4.6 gm/dl
Total protein...........................6.0 to 8.2 gm/dl