Kidney transplant

Definition

A kidney transplant is a surgical procedure to place a healthy kidney from a donor into a person whose kidneys no longer function properly.

Your kidneys remove excess fluid and waste from your blood. When your kidneys lose their filtering ability, dangerous levels of fluid and waste accumulate in your body — a condition known as kidney failure. A kidney transplant is often the best treatment for kidney failure.

Only one donated kidney is needed to replace two failed kidneys, making living-donor kidney transplantation an option. If a compatible living donor isn't available for a kidney transplant, your name may be placed on a kidney transplant waiting list to receive a kidney from a deceased donor. The wait could be a year or more.

Why it's done

A kidney transplant is used to treat kidney failure, a condition in which your kidneys can function at only a fraction of normal capacity. People with end-stage kidney disease need either artificial blood filtering (dialysis) or a kidney transplant to stay alive.

Common causes of end-stage kidney failure include:

• Diabetes
• Chronic, uncontrolled high blood pressure
• Chronic glomerulonephritis — an inflammation and eventual scarring of the tiny filters within your kidneys (glomeruli)

Sometimes kidney failure can be managed with diet, medication and treatment for the underlying cause. If despite these steps, your kidneys still can't filter your blood properly, you might be a candidate for a kidney transplant. In fact, if you have no other life-threatening medical conditions, a kidney transplant could be a better option than dialysis because it may provide a better long-term quality of life.

Risks

Complications of the procedure
Kidney transplant surgery carries a risk of significant complications, including:

• Blood clots
• Bleeding
• Leaking from or blockage of the tube (ureter) that links the kidney to the bladder
• Infection
• Failure of the donated kidney
• Rejection of the donated kidney

Anti-rejection medication side effects
After a kidney transplant you'll take medications to help prevent your body from rejecting the donor kidney. These medications can cause a variety of side effects, including:

• Bone thinning
• High cholesterol
• High blood pressure
• Diabetes
• Skin sensitivity
• Puffiness
• Weight gain
• Swollen gums
• Acne
• Excessive hair growth

How you prepare

Choosing a transplant center
If your doctor recommends a kidney transplant, you may be referred to a transplant center. You're also free to select a transplant center on your own or choose a center from your insurance company's list of preferred providers.

When you're considering transplant centers, you may want to:

• Learn about the number and type of transplants the center performs each year.
• Ask about the transplant center's organ donor and recipient survival rates.
• Compare transplant center statistics through the Web database maintained by the Scientific Registry of Transplant Recipients.
• Consider additional services provided by the transplant center, such as coordinating support groups, assisting with travel arrangements, helping with local housing for your recovery period and offering referrals to other resources.

After you've selected a transplant center, you'll need an evaluation to determine whether you meet the center's eligibility requirements for a kidney transplant.

The team at the transplant center will assess whether you:

• Are healthy enough to have surgery and tolerate lifelong post-transplant medications
• Have any medical conditions that would hinder transplant success
• Are willing and able to take medications as directed

Finding a donor
A kidney donor can be living or deceased, related or unrelated to you. Your health care team will consider factors such as blood and tissue types when evaluating if a living donor will be a good match for you. Family members are often the most likely to be compatible kidney donors. But many people undergo successful transplants with kidneys donated from people who are not related to them.

If a compatible living donor isn't available, your name will be placed on a waiting list for a deceased-donor kidney. Because of the success of kidney transplants in treating kidney failure, the waiting list has grown significantly over the last 20 years. The waiting time for a deceased donor kidney can be a year or more.

Staying healthy
Whether you're waiting for a donated kidney or your transplant surgery is already scheduled, it's important to stay healthy.

• Take your medications as prescribed.
• Follow your diet and exercise guidelines.
• Keep all appointments with your health care team.
• Stay involved in healthy activities, including relaxing and spending time with family and friends.

If you're waiting for a donated kidney, make sure the transplant team knows how to reach you at all times. Keep your packed hospital bag handy, and arrange transportation to the transplant center in advance.

What you can expect

During a kidney transplant
Kidney transplants are performed with general anesthesia, so you're unconscious during the procedure. The anesthesiologist or anesthetist gives you an anesthetic medication as a gas — to breathe through a mask — or injects a liquid medication into a vein.

The surgical team monitors your heart rate, blood pressure and blood oxygen throughout the procedure with a blood pressure cuff on your arm and heart-monitor wires attached to your chest. After you're unconscious:

• The surgeon makes an incision and places the new kidney in your lower abdomen. Unless your own kidneys are causing complications such as high blood pressure or infection, they are left in place.
• The blood vessels of the new kidney are attached to blood vessels in the lower part of your abdomen, just above one of your legs.
• The new kidney's ureter — the tube that links the kidney to the bladder — is connected to your bladder.

Kidney transplant surgery usually lasts about three to five hours.

After a kidney transplant
After your kidney transplant, you can expect to:

• Spend about 3 to 5 days in the hospital. Doctors and nurses monitor your condition in the hospital's transplant recovery area to watch for signs of complications. Your new kidney will make urine like your own kidneys did when they were healthy. Often this starts immediately. In other cases it takes up to a few weeks. Expect soreness or pain around the incision site while you're healing.
• Have frequent checkups as you continue recovering. After you leave the hospital, close monitoring is necessary for three to four weeks. Your transplant team will develop a checkup schedule that's right for you. During this time, if you live in another town, you may need to make arrangements to stay close to the transplant center.
• Take medications the rest of your life. You'll take a number of medications after your kidney transplant. Drugs called immunosuppressants help keep your immune system from attacking your new kidney. Additional drugs help reduce the risk of other complications, such as infection, after your transplant.

Kidney transplant

Kidney transplant

During kidney transplant surgery, the donor kidney is placed in your lower abdomen. Blood vessels of the new kidney are attached to blood vessels in the lower part of your abdomen, just above one of ...

Results

After a successful kidney transplant, your new kidney will filter your blood, so you will no longer need dialysis. But, unless the kidney is donated by an identical twin, your immune system will try to reject your new kidney. So you'll require medications to suppress your immune system. You'll likely take these or similar drugs for the rest of your life. Because medications to suppress your immune system make your body more vulnerable to infection, your doctor may also prescribe antibacterial, antiviral and antifungal medications.

Kidney transplant survival rates
According to the Organ Procurement and Transplantation Network:

• About 95 percent of people who receive a living-donor kidney transplant have a functioning kidney after one year. After five years, that rate is about 80 percent.
• About 92 percent of people who receive a deceased-donor kidney transplant have a functioning kidney after one year. Five years after transplant, the rate is about 70 percent.

If your new kidney fails, you can resume dialysis or consider a second transplant. You may also choose to discontinue treatment. This important decision depends on your current health, your ability to withstand surgery and your expectations for maintaining a certain quality of life.