Recipient Evaluation

The recipient evaluation is shown in Table 12B.2.2 Potential recipients are evaluated by a team composed of pediatric nephrologists,surgeons, neurologists, nutritionists, psychologists, and social workers. The history and physical examination are aimed at identifying associated congenital anomalies, documenting height, weight, and head circumference, and determining neurologic development. Blood is obtained for CBC, platelet count, electrolytes, calcium, phosphorus, albumin, type and crossmatch, HLA typing, and viral serology (i.e., cytomegalovirus, Epstein-Barr virus, herpes simplex virus, varicella zoster, measles, mumps, and rubella). A urinalysis, chest x-ray, electrocardiogram, electroencephalogram, abdominal ultrasound, and vesicourethrogram (if indicated by history or prior renal ultrasound) or voiding cytourethrogram are also obtained. Pneumococcal and hepatitis B vaccines are given 6 weeks pretransplant.

The need and timing of native nephrectomy is also determined. Indications for nephrectomy include renal infection, severe hypertension, congenital nephrotic syndrome, reflux nephropathy, and polycystic kidneys.2 Recipients < 16 kgs will have an intraabdominal transplant so nephrectomy is performed at transplant. Recipients > 16 kgs will have an extraperitoneal transplant so their native kidneys are removed pretransplant.

The selection criteria for pediatric recipients are liberal. Absolute contraindications include active infection, uncontrolled malignancy, and positive T-cell crossmatch.

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