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Patient Instructions

A kidney transplant is surgery to place a healthy kidney into a person with kidney failure.

Kidney transplants are one of the most common transplant operations in the United States.

One donated kidney is needed to replace the work previously done by your kidneys.

The donated kidney may be from:

• Living related donor -- related to the recipient, such as a parent, sibling, or child
• Living unrelated donor -- such as a friend or spouse
• Deceased donor -- a person who has recently died and who has no known chronic kidney disease

The healthy kidney is transported in cool salt water (saline) that preserves the organ for up to 48 hours. This gives the health care providers time to perform tests that match the donor's and recipient's blood and tissue before the operation.

PROCEDURE FOR A LIVING KIDNEY DONOR

If you are donating a kidney, you will be placed under general anesthesia before surgery. This means you will be asleep and pain-free. The procedure used to require a long surgical cut. However, today surgeons can use a short surgical cut (mini-nephrectomy) or laparoscopic techniques. See Kidney removal for more information.

PROCEDURE FOR THE KIDNEY RECIPIENT

People receiving a kidney transplant are given general anesthesia before surgery. The surgeon makes a cut in the lower belly area.

• Your surgeon places the new kidney inside your lower belly. The artery and vein of the new kidney are connected to the artery and vein in your pelvis. Your blood flows through the new kidney, which makes urine just like your own kidneys did when they were healthy. The tube that carries urine (ureter) is then attached to your bladder.
• Your own kidneys are left in place, unless they are causing high blood pressure, infections, or are too large for your body. The wound is then closed.

Kidney transplant surgery takes about 3 hours. People with diabetes may also have a pancreas transplant done at the same time. This will usually add another 3 hours to the surgery.

See also: Pancreas transplant

End-stage kidney disease occurs when the kidneys no longer remove wastes and excess fluids, and manage electrolytes (such as sodium and potassium) and minerals. They also no longer make hormones that keep your bones strong and your blood healthy.

As a result, harmful wastes build up in your body. Your blood pressure may rise, and your body may hold on to excess fluid and not make enough red blood cells.

The most common cause of end-stage kidney disease in the U.S. is diabetes. However, there are many other causes of chronic renal failure and end-stage kidney disease.

A kidney transplant may NOT be recommended if you have:

• Certain infections, such as TB or osteomyelitis
• Difficulty taking medications several times each day for the rest of your life
• Heart, lung, or liver disease
• Other life-threatening diseases
• History of cancer
• Infections such as hepatitis that are considered to be active
• Smoking, alcohol or drug abuse, or other risky lifestyle habits

The risks for any anesthesia are:

• Problems breathing
• Reactions to medications

The risks for any surgery are:

• Bleeding
• Infection

Other risks related to the procedure include:

• Blood clots (deep venous thrombosis)
• Heart attack or stroke
• Wound infections
• Side effects from medications used to prevent transplant rejection, including:
  • Increased risk for infections
  • Damage to your liver or other organs

Once your doctor refers you to a transplant center, you will be seen and evaluated by the transplant team. They will want to make sure that you are a good candidate for kidney transplant. You will have several visits over the course of several weeks or even months. You will need to have blood drawn and x-rays taken.

Tests done before the procedure include:

• Tissue and blood typing to help make sure your body will not reject the donated kidney
• Blood tests or skin tests to check for infections
• Heart tests such as an EKG, echocardiogram, or cardiac catheterization
• Tests to look for early cancer

You will also want to consider one or more transplant centers to determine which is best for you.

• Ask the center how many transplants they perform every year and what their survival rates are. Compare these numbers to those of other transplant centers.
• Ask about support groups they have available and what type of travel and housing arrangements they offer.

If the transplant team believes you are a good candidate for a kidney transplant, you will be put on a national waiting list.

• Your place on a waiting list is based on a number of factors. Key factors include the type of kidney problems you have, how severe your heart disease is, and the likelihood that a transplant will be successful.
• The amount of time you spend on a waiting list is usually not a factor in how soon you get a kidney, except maybe for children.

Most, but not all patients waiting for a kidney transplant are on dialysis. While you are waiting for a kidney, follow these steps:

• Follow any diet your transplant team recommends.
• Do not drink alcohol.
• Do not smoke.
• Keep your weight in the range that has been recommended. Follow any recommended exercise program.
• Take all medicines as they have been prescribed for you. Report changes in your medications and any new or worsening medical problems to the transplant team.
• Follow up with your regular doctor and transplant team on any appointments that have been made.
• Make sure the transplant team has the correct phone numbers so they can contact you immediately if a kidney becomes available. Make sure, no matter where you are going, that you can be contacted quickly and easily.
• Have everything ready in advance to go to the hospital.

If you received a donated kidney, you will need to stay in the hospital for about 3 - 7 days. Afterwards, you will need close follow-up by a doctor and regular blood tests for 1 - 2 months.

The recovery period is about 6 months. Often, your transplant team will ask you to stay fairly close to the hospital for the first 3 months. You will need to have regular check-ups with blood tests and x-rays for many years.

Almost everyone feels that they have a better quality of life after the transplant. For those who receive a close match, up to 90% are still alive after 1 year, and more than 70% are alive after 5 years. Those who receive a kidney from a living related donor do better than those who receive a kidney from a donor who has died. (If you donate a kidney, you can usually live safely without complications with your one remaining kidney.)

People who receive a transplanted kidney may reject the new organ. This means that their immune system sees the new kidney as a foreign substance and tries to destroy it.

In order to avoid rejection, almost all kidney transplant recipients must take medicines that suppress their immune response for the rest of their life. This is called immunosuppressive therapy. Although the treatment helps prevent organ rejection, it also puts patients at a higher risk for infection and cancer. If you take this medicine, you need to be regularly screened for cancer. The medicines may also cause high blood pressure and high cholesterol and increase the risk for diabetes.

A successful kidney transplant requires close follow-up with your doctor and you must always take your medicine as directed.

Renal transplant; Transplant - kidney

Barry JM, Jordan ML, Conlin MJ. Renal transplantation. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 40.

Updated by: Louis S. Liou, MD, PhD, Assistant Professor of Urology, Department of Surgery, Boston University School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.