Infection is a common complication that can occur after kidney transplantation.

The immune system is your child's defense against foreign invaders in the body, such as bacteria and viruses. The risk of infection is greater after transplantation because the immune system has been slowed down by the transplant immunosuppressant medications, making it harder for your child's body to fight infection.

This risk is greatest in the first few months after transplant, when the doses of these medications are the highest. As these doses are reduced, your child will be less susceptible to infection since your child's immune system will not be as suppressed.

Below are some things that the Pediatric Kidney Transplant Program team at Cincinnati Children's recommends both you and your doctor do before and after transplant to reduce your child's risk of infection.

Before Transplant

• Blood tests will be done to find out if your child has already been exposed to several viruses that can be a problem after transplant, such as hepatitis B & C, chicken pox (varicella), cytomegalovirus (CMV), Epstein-Barr virus ("mono"; EBV), and herpes simplex virus (HSV). This information will be used to make sure that your child has been immunized against as many viruses as possible before transplant. For example, your child may need to receive vaccines or booster vaccines for chicken pox and hepatitis B if these blood tests show that your child doesn't already have antibodies against them.
• Check with your primary care doctor to make sure that your child is up to date on all other immunizations. After the transplant, your child will not be able to receive live-virus vaccines, such as the MMR (measles, mumps, and rubella) vaccine or the chicken pox (varicella) vaccine. It's best for your child to be protected against as many viruses as possible before they start taking immunosuppressant medications.
• Visit your child's dentist for a check-up and have any problems that could cause infection, such as cavities or abscesses, taken care of before the transplant.
• Make sure your child stays as healthy as possible before the transplant. Follow the doctor's instructions for dialysis, diet and medications. Your child will recover and heal more quickly and be less susceptible to infection after the transplant if they are in good shape going into it.

After Transplant

• Since your child will be at the highest risk for infection in the first six to eight weeks after transplant, there will be some restrictions during that period, such as avoiding crowded, enclosed places where there are lots of germs, like large shopping centers, malls or movie theatres. Your child may also be asked to wear a mask when they return to the hospital for their follow-up clinic visits in order to protect them from the germs inside the hospital. Your child will not have to wear a mask outside or within your house with your family members.
• Your child should avoid being around people who are visibly ill, should never share eating utensils or cups, and should wash their hands frequently.
• Your child will probably take some medications for the first few months after transplant to help protect against bacterial, viral and fungal infections. Be sure to follow the medication instructions.
• Notify the transplant team immediately if your child has any symptoms of infection such as fever, chills, rash, cough, vomiting, diarrhea, or pain when they urinate. If you are in doubt, it's always safer to call to discuss your concerns.