After Pediatric Kidney Transplant Surgery

After transplantation, your child’s immune system will not recognize the new kidney and may try to attack or reject it. That’s why it is important to get a kidney that matches your child’s immune system.. Your child will also take immunosuppressant medicine to help prevent rejection. It is essential that your child takes these medications as prescribed. We personalize their immunosuppression strategy based on their specific needs. Our goal is to keep the transplanted kidney working for a long time.

Signs of rejection can include fever, decreased urine output, and weight gain, but your child may not show any symptoms at all. They will undergo a kidney biopsy about six months after transplant as well as regular blood work to test for rejection. Rejection can be treated successfully if problems can be addressed promptly -- usually with steroids and an increased dose of immunosuppressants.

We offer both calcineurin-free and steroid-free anti-rejection medications tailored to your child’s specific needs. These options help your child avoid the long-term side effects associated with steroid use and help the transplanted kidney function longer. Your child will take immunosuppressants for the rest of their life. Because their body and immune system can change over time, we will monitor your child closely and adjust the dosage and medication type as needed.

Your child will also take drugs to lower the risk of infections, prevent blood clots, control acid reflux, and more. Your transplant pharmacist, transplant coordinator, and others will help you and your child manage and follow their medication routine.

Your child will have frequent visits with the transplant team for the first three months after leaving the hospital Your child’s transplant coordinator will help you with your appointment schedule and help you find lodging, if needed. At every follow-up visit, your child will undergo testing to see how well they’re healing, monitor any medication side effects, and look for signs of rejection or infection. Over time, these visits will occur less often, but you will still need to return to Duke for regular appointments. 

You will be asked to keep track of your child’s blood pressure, pulse, weight, temperature, fluid intake, and urine output daily. Please bring the recorded information to all follow-up appointments. Changes in vital signs may indicate a need for medical attention.

Immunosuppression medications help your child’s body accept their new kidney, but they also increase the risk for infections, such as a cold; the flu; urinary tract infections; or other viral, bacterial, or fungal illnesses. This risk is greatest in the first year after transplant and when they are on high doses of medication -- for instance, when being treated for an episode of rejection. By consistently washing their hands, avoiding crowds and sick people, and getting vaccines as recommend, they can lower their risk for infection.