Evaluation Tests and Procedures
The evaluation process includes a thorough assessment of your child with numerous tests and procedures that allows the transplant team to gain valuable information about the health status of your child. The results and information that is obtained from this evaluation help the transplant team determine if a transplant is the best way to treat your child. No two intestinal transplant evaluations are alike, however, there is a basic backbone structure that is followed and then catered toward your child’s individual needs. The evaluation may include:
Routine Assessment: Complete history and physical exam
Growth and Development: The transplant team will evaluate your child's growth and development. This may mean meeting with individuals from the physical therapy, occupational therapy, speech therapy, child life, and child development departments.
Psychological and Social Evaluation: You and your child may meet with a psychologist or psychiatrist and a social worker. A transplant is a big operation and a lifelong commitment on the part of you and your child. Many changes to you and your child’s life will occur after transplant that will have to be maintained for the remainder of his or her life and will impact not only your child, but also your family. The goal is to make sure your child has the greatest chance of success with his or her transplant. The transplant team wants to make sure the child has enough family support before and after the transplant to accomplish this goal.
Gastrointestinal Assessment: A barium swallow and/or barium enema may be performed to examine the bowel length, intestinal defects, anatomy or structure, and functioning of the intestine via a series of x-ray and ingested contrast dye.
Nutritional Assessment: Nutritional status is very important to assess during an intestinal transplant evaluation. Many children with intestinal problems who are candidates for transplantation often have problems with unusual eating habits or oral aversion.
Occupational therapists or speech therapists may be consulted to help your child overcome difficulties your child has with eating and drinking so your child will be prepared to eat by mouth after transplant.
Blood tests for nutritional status will be conducted to assess vitamins and minerals, such as measuring the levels of fat-soluble vitamins A, D, E, and K.
Hepatic (Liver) Function: Blood tests will be used to assess the function of the liver. An ultrasound or CT scan may also be used to assess the liver and other internal abdominal organs. Your child may need to undergo a liver biopsy (taking a small sample of the liver) to assess the status of the liver’s function and determine if your child will need to have the liver transplanted in addition to the intestine.
Vascular Patency: This means examining your child’s blood vessels to make sure that they are open and not obstructed or blocked. This may be done by using an ultrasound, a CT scan, or an angiogram. During an angiogram, a dye is injected into your child’s blood vessel and observed via x-rays taken to see how well the dye moves through the vessels. This information is important to determine if any vessels are blocked that may be needed for transplant.
Cardiac (heart) Assessment: It is important to make sure that your child’s heart is functioning correctly and make sure that there are not any structural defects within the heart that have gone undetected. Your child will probably have an electrocardiogram (EKG) to check the electrical activity of the heart. This is a painless procedure that involves placing sticky electrodes on the skin and measuring the electrical activity. Your child will also probably have an echocardiogram which is a special ultrasound that looks at the anatomy of the heart to look for structural defects and see the heart beating in real time.
Respiratory (Lung) Assessment: Your child will have a chest x-ray to make sure the lungs are clear. Your child may undergo a chest CT scan to get an even better image.
History of Infection and Immune System Assessment: Since the immunosuppressant medicines transplant recipients take weaken the immune system, it is important to have a good idea of how your child's immune system has worked in the past. Your transplant team will probably ask you for a thorough history of your child’s illnesses and vaccine status. Blood tests will also help assess the status of your child’s immune system.
Blood and Tissue Type: Blood tests will be done to determine your child’s blood type (A, B, O, or AB; positive or negative) and tissue type. For intestinal transplant matching, blood type is what is considered when matching organs. Tissue typing may be considered if your child is being matched with a liver.