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PRE-TRANSPLANT Pretransplant tests are designed to provide a good overall picture of a transplant patient’s health. They will also help identify other issues which may cause complications during the process. The following list outlines many of the tests – and what they help measure - used to test a patient pretransplant: Physical exam – General overview of the patient's various conditions Chest x-ray - Lungs and lower respiratory tract Electrocardiogram (EKG or ECG) – Heart health and past undetected heart damage Ultrasound with Doppler examination - Iliac vessels function Blood tests – Blood count, blood and tissue type, blood chemistries, immune system function and blood tests for certain infectious diseases will also be performed Blood typing – To determine if you are blood type A, B, AB or O Pulmonary function – Lung function and the blood's capacity to carry oxygen Upper gastrointestinal (GI) series - Esophagus and stomach checks for disease Lower GI series – Intestinal problems Renal function studies – How well the kidneys are working; kidney function can also be measured with the serum creatinine test which is a blood test Tissue typing – Markers on white blood cells which determine tissue type used to find an appropriate kidney match Panel Reactive Antibody (PRA) – Immune system activity - higher PRA means more antibodies are being made; the less activity here, the better chance the body will not reject the transplanted kidney Viral testing – Test for exposure to diseases such as hepatitis, cytomegalovirus, Epstein-Barr, and acquired immune deficiency syndrome Mammogram – Presence of breast cancer Pap smear – Presence of cervical cancer Echocardiogram – Heart abnormalities Dental Evaluations – Healthy teeth and gums (regular dental check ups are necessary while waiting for a transplant)
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Histocompatibility Laboratory Tests Histocompatibility is a condition in which the cells of one tissue can survive in the presence of cells of another tissue. Tissue Typing – Ensures proper kidney (organ) match. This test is done on white blood cells which have special "markers" which give you a "tissue type". Tissue type is inherited from your parents. Panel Reactive Antibody (PRA) - Immune system activity test. The calmer your immune system is, the easier it will be to get a kidney. A higher immune system activity means your body fights foreign objects (like a transplanted kidney) more vigorously. Blood transfusions, pregnancy, previous transplant(s) or a current infection can cause your immune system to be more aggressive. Crossmatch Testing – When a kidney is available, your blood and the blood of the donor kidney are tested. With a negative crossmatch, (no reaction) you are "compatible" with the donor. A positive crossmatch (reaction) the kidney will not work for you because it is "incompatible".
Clinical Laboratory Tests Blood Typing - There are four main blood types. (A, B, AB and O). The donor's blood type does not have to be the same. However, it must be "compatible" with your blood type for you to receive the kidney. BLOOD TYPE COMPATIBILITY CHART
Viral Testing – For a kidney transplant to be successful, it is important to know if the patient has ever been exposed to hepatitis, cytomegalovirus (CMV), Epstein-Barr virus (EBV), or acquired immune deficiency syndrome (AIDS).
POST-TRANSPLANT Clinic Visits The patient will receive a schedule of follow-up clinic visits for lab tests and checkups when they leave the hospital. This is done to detect possible complications as quickly as possible and ensure overall health and well-being is good after the transplant.
Lab Tests Kidney function, blood count, electrolytes and levels of medication in the patient’s blood are all monitored in typical lab tests. However, other tests may be ordered if needed. Blood Count Tests: WBC – (White Blood Cells) Monitors the increase or decrease of white blood cells to determine if there could be an infection or if the body has a lower defense against infection. HCT - (Hematocrit) Percent of red cells within the blood - red blood cells carry oxygen to the body so when hematocrit is low, it could cause the feeling of tiredness or having no energy. PLT – (Platelet) Platelets help the blood clot after an injury - low platelet levels can cause easy bruising and longer bleeding time after an injury or operation.
Kidney Function Tests: Creatinine and BUN are waste products normally removed by the kidneys. These tests measure the amount of creatinine and blood urea nitrogen to determine how well the kidneys are doing their job.
Electrolyte Tests: Electrolytes are dissolved minerals present in the human body. The balance of the electrolytes in our bodies is essential for normal function of our cells and our organs. Electrolytes tested and their function in the body: Ca (Calcium) Strong bones, teeth, blood clotting, and heart and nerve function PO4 (Phosphate) Strong bones (works with calcium) Mg (Magnesium) Muscle function and blood clotting K (Potassium) Heart and muscle function Na (Sodium) Salt and water balance CO2 (Bicarbonate) Acid balance Cl (Chloride) salt and water balance
Other blood tests: Drug levels measure the amount of immunosuppressant medication (e.g. Tacrolimus or Cyclosporine) in your blood. These levels must be checked regularly. High levels could lead to toxicity or over-immunosuppression, and low levels may lead to rejection. A “normal range” will vary for every patient based on medications and length of time since transplant. Glucose tests measure sugar levels in the blood. For some patients, certain medications can produce a diabetes-like condition in which blood-sugar levels are too high.
ADDITIONAL TESTS AND PROCEDURES The following tests may also be used to keep tabs on a patient's transplant: Ultrasound – Checks for abnormal collections of fluid (blood) and allows monitoring of the main blood vessels leading to the kidney to ensure they are functioning normally. Kidney biopsy – Used to test for rejection, this test involves the use of a needle to obtain a small piece of the kidney which can be viewed under a microscope and be checked for rejection, or other possible problems. This may be done in the hospital or in the outpatient/short-stay unit. Computerized tomography (CT) scan – A multi-view X ray which allows a physician to detect possible infections, fluid collections, or other problems in or around the kidney. Magnetic resonance imaging (MRI) – Similar to a CT scan in terms of producing images, this test also allows a patient's kidney to be viewed from different angles and in three-dimensional images. An MRI shows soft tissues, such as the kidney, more clearly than a CT scan.
AAKP My Health is a free personal health record offered by the American Association of Kidney Patients (AAKP). It allows you to monitor your lab values and gives you an idea of what they may mean for your condition, ask more informed questions from your healthcare team and increase your general knowledge of kidney disease. Register today!
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