At the Kidney Transplant Program, we use the latest diagnostic technology to assess your child’s kidneys. This pre-transplant evaluation helps our team determine how urgently your child needs a kidney transplant.
Your child doesn’t need to have kidney failure or be on dialysis to qualify for a kidney transplant at Children’s Hospital Los Angeles. In some cases, our team performs kidney transplants before a child becomes severely ill and needs dialysis. This is a preemptive transplant.
Pediatric Kidney Transplant Evaluations
Our Nephrology (kidney) Clinic and Kidney Transplant Clinic perform comprehensive testing. Our experts use these tests to determine the type and severity of your child’s kidney condition.
These diagnostic tests may take place during your child’s pre-transplant evaluation. Your child may also get some of these tests while they wait for a kidney transplant.
Healthy kidneys remove waste from blood and excess fluids from the body. Blood tests show how well your child’s kidneys are working. These tests also provide important information that helps our doctors find the best kidney match.
Blood tests may include:
- Blood typing (also called ABO compatibility) to help determine a good organ match.
- Genetic tests to check for gene changes or mutations that cause kidney diseases.
- Human leukocyte antigen (HLA) testing to check for a compatible organ match between your child and a donor.
Urine tests help our team identify high levels of protein, blood, sugar and other substances in your child’s urine. Test results help us diagnose kidney conditions and urinary tract disorders.
Our Radiology and Imaging team uses the latest technology to take high-quality images of the kidneys and surrounding abdominal organs.
Your child may get these imaging scans:
- Ultrasound to check for changes in the size, shape or positioning of the kidneys or bladder. An ultrasound can also show kidney cysts, kidney tumors and kidney stones.
- CT scan to check for structural changes to the kidneys, as well as blockages.
During a kidney biopsy, a pediatric kidney specialist (nephrologist) removes small samples of tissue from your child’s kidney to help diagnose the type of kidney disease. Biopsies take place while your child is under deep sedation, so they sleep through the procedure. After transplant, your child will also need occasional biopsies of the transplanted kidney.
Pediatric Dialysis: Pre-Kidney Transplant Treatments
When your child has kidney failure, their kidneys can’t filter waste from blood and remove excess fluids. Dialysis can take over some of the jobs performed by the kidneys. Although a child can get dialysis for many years, the treatment is time-consuming and can cause complications. A kidney transplant offers your child the best chance of a long and fulfilling life. Dialysis can help your child until a donor kidney becomes available.
In 1967, CHLA became one of the first pediatric centers in the country to provide comprehensive dialysis services for children with kidney failure. We now have one of the largest, most experienced outpatient pediatric dialysis units in the country. A member of our dialysis team is available 24/7 to answer your questions.
Types of pediatric dialysis
Our top-rated Nephrology Division offers inpatient and outpatient dialysis services for children of all ages. Your child’s care team will help choose the dialysis method that works best for your child and family.
Dialysis options include:
- Inpatient continuous renal replacement therapy (CRRT) for infants and older children
- Outpatient hemodialysis at CHLA
- At-home peritoneal dialysis
Continuous renal replacement therapy (CRRT)
Some babies with kidney issues need dialysis immediately after birth or during infancy. We offer continuous renal replacement therapy (CRRT) to infants weighing as little as 5 pounds. Specialists in our nationally recognized Fetal and Neonatal Institute and Nephrology Division work as a team to provide this care.
CRRT is a longer, slower type of dialysis that filters your child’s blood 24 hours a day. It can help very ill children of all ages who are too sick to tolerate other types of dialysis. This therapy takes place in our Newborn and Infant Critical Care Unit (NICCU), Pediatric Intensive Care Unit (PICU) or Cardiothoracic Intensive Care Unit (CTICU).
Hemodialysis takes place at our outpatient pediatric dialysis unit, one of the largest in the country. A machine removes blood from your child’s body and sends it through a filter called a dialyzer. The machine then returns the cleansed blood back to your child.
Hemodialysis can take 3 to 4 hours and must occur 3 to 4 days a week. Our dialysis nurses provide exceptional care while your child gets dialysis. To help your child and you pass the time, our dialysis unit offers free Wi-Fi, movies, games and books. We also offer a school for patients so your child can stay current on their schoolwork.
Peritoneal dialysis takes place at your home. You may use a machine or perform the procedure manually. Our dialysis nurses teach you how to perform this treatment and ensure you feel confident providing this in-home care for your child. We’re always available if you have problems.
Before your child starts peritoneal dialysis, we perform a minor surgical procedure to place a catheter (thin, flexible tube) into their belly. Peritoneal dialysis involves sending a cleansing solution through the catheter and into your child’s abdomen. The solution pulls waste and fluid through a layer of tissue called the peritoneal membrane that lines the abdominal cavity. The membrane acts as filter to remove waste from your child’s body.
Continuous cyclic peritoneal dialysis (CCPD)
Continuous cyclic peritoneal dialysis (CCPD) is another option. CCPD uses a machine and takes place at night. During CCPD:
- You connect your child’s catheter to a machine called a cycler.
- The machine pumps or “cycles” the solution in and out of your child’s abdomen while they sleep.
Comprehensive Pediatric Kidney Transplant Options
If tests indicate that your child needs a kidney transplant, we evaluate whether they’re ready for a transplant and determine the best transplant option. When appropriate, we place your child on the national transplant waitlist. This waitlist is for a kidney from a deceased donor. Your child may be able to get a new kidney faster from a family member or another adult through our living donor kidney transplant services.
Advanced Tests for a Successful Organ Match
When your child gets a donor kidney, their immune system views proteins called human leukocyte antigen (HLA) markers in the donor organ as foreign. As a result, your child’s body may try to reject the donor kidney.
To lower this risk, specialists in our HLA lab perform advanced HLA typing to find the best organ match for your child. Our team is also investigating new ways to improve organ matching.
Some children have high levels of anti-HLA donor-specific antibodies (DSAs). These antibodies increase the risk of organ rejection from certain donors. For these children, HLA testing in our lab improves the chances of finding a compatible donor.
Focus on post-kidney transplant care
After a kidney transplant, your child will take immunosuppressants and other medications. These medications prevent your child’s immune system from damaging and rejecting the donor kidney. Unfortunately, these medications weaken your child’s immune system, making it harder to fight illnesses and infections. We closely monitor your child’s health after transplantation for signs of organ rejection and illness.
To improve post-transplant care, researchers at The Saban Research Institute of Children’s Hospital Los Angeles are investigating new ways to assess organ rejection risk factors. The goal is to customize immunosuppression therapy for each child’s unique health situation.
Kidney Transplants at Children's Hospital Los Angeles
Our kidney transplant team is among the best in the country. You can trust us to pinpoint the cause of your child’s kidney condition and keep them strong until they get a transplant. Learn more about our Kidney Transplant Program.
The Kidney Transplant Program at CHLA welcomes new patients, referrals and second opinions. Please contact us to make an appointment.