Sarah Lewis, PharmD
What is a kidney transplant?
A kidney transplant is the surgical placement of a donor kidney to take over the work of damaged or diseased kidneys. It is a treatment for end-stage kidney disease and other severe kidney conditions. Kidney transplantation is a life-saving surgery used when all other medical and surgical options have failed.
A kidney transplant is a major surgery with serious risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all your treatment choices before having a kidney transplant.
Types of kidney transplant
The types of kidney transplant surgery include:
Deceased donor transplant uses a healthy kidney from a person who has just died or who is brain-dead to take over the work of a damaged or diseased recipient’s kidneys.
Living donor transplant uses a live person’s kidney to take over the work of a damaged or diseased recipient’s kidneys. A person who donates a kidney can live a normal life with one healthy kidney to meet their body’s needs. Living donors are usually a family member or close friend of the recipient.
Other procedures that may be performed
Diseases that cause serious damage to the kidney can also cause serious damage to other organs, including the liver, lung and heart. Another organ may be transplanted during a kidney transplant in rare cases. Your doctor and transplant care team will determine if a combination transplant procedure is right for you.
Other transplant surgeries include:
Heart transplant replaces a diseased or damaged heart with a donor heart.
Liver transplant replaces a diseased or damaged liver with a donor liver.
Lung transplant replaces a diseased or damaged lung with a donor lung.
Pancreas transplant replaces a diseased pancreas with a donor pancreas. This is the most commonly performed with a kidney transplant.
Why is a kidney transplant performed?
Your doctor may recommend a kidney transplant to treat end-stage kidney (renal) disease (ESRD). In ESRD, your kidneys are no longer capable of filtering waste products and fluid out of the blood. As a result, waste products and fluids buildup in the body. ESRD is fatal without hemodialysis (artificial filtering of your blood) or kidney transplantation.
Causes of ESRD include:
Autoimmune diseases, such as systemic lupus erythematosus
Hereditary kidney diseases
High blood pressure
Your doctor will only consider a kidney transplant for you if other medical and surgical treatment options have failed. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on a kidney transplant.
Who performs a kidney transplant?
The following specialists perform kidney transplants:
Transplant surgeons specialize in transplant surgery of the kidney, liver, pancreas, and other organs.
General surgeons specialize in the surgical treatment of a wide variety of diseases, disorders and conditions.
Pediatric surgeons specialize in surgery for infants, children and adolescents.
How is a kidney transplant performed?
Your kidney transplant will be performed in a hospital. Kidney transplant surgery takes from three to four hours. It is an open surgery that involves making an incision in the lower abdomen. The incision runs from the pubic bone to the hipbone. Open surgery allows your doctor to directly view and access the surgical area.
Your surgeon will place the donor kidney through this incision and attach the kidney’s ureter (tube that carries urine from the kidney to the bladder) to your bladder. Your surgeon will also establish blood supply to your new kidney. In most cases, your own kidneys will remain in place. However, sometimes your surgeon will remove them to improve your health.
Your surgeon will advise you on which procedure is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different types of kidney transplant and ask why your surgeon will use a particular surgery for you.
What to expect while on the kidney transplant waiting list
If you are eligible for a kidney transplant but do not have an eligible family member or friend who can donate a kidney, you will be placed on a kidney transplant waiting list. A variety of factors determines who gets a donor kidney when one becomes available. These factors include tissue and blood matching.
Sometimes a donor kidney matches to more than one person on the waiting list. In this case, length of time on the waiting list and physical proximity to the donor kidney also play a role in who gets the donor kidney.
Once a donor kidney is matched to you, it generally needs to be transplanted within 24 hours or less. You may already be in the hospital because of your condition. If not, most transplant centers require you to be in immediate contact range while on the waiting list. Your transplant center may expect you to arrive at the hospital within two hours of contact.
Types of anesthesia that may be used
Your surgeon will perform a kidney transplant using general anesthesia. General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain.
You may also have a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.
What to expect the day of your kidney transplant
The transplant center will call you when a kidney is ready for you. When you arrive at the transplant center, you can generally expect to:
Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with family member. The surgical team will give you blankets for modesty and warmth.
Talk with the anesthesiologist or nurse anesthetist about your anesthesia.
A surgical team member will start an IV.
The anesthesiologist or nurse anesthetist will start your anesthesia.
A tube will be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.
A catheter (tube) will be placed in your bladder to collect urine during and after the surgery.
The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the surgery and your recovery until you are alert, breathing effectively, and your vital signs are stable.
What are the risks and potential complications of a kidney transplant?
As with all surgeries, a kidney transplant involves risks and possible complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding, which can lead to shock
Potential complications of a kidney transplant
Potential complications of a kidney transplant include:
Acute tubular necrosis or “sleepy kidney,” which is when the transplanted kidney is slow to function after the transplant procedure. Temporary dialysis may be necessary to allow the transplanted kidney to heal and regain function.
Complications from anti-rejection drugs including cancer and other side effects
Complications from not following your lifelong healthcare plan necessary after transplantation
Failure of the donor kidney
Lymphocele, which is a collection of lymph fluid around the kidney putting pressure on the kidney and ureter
Recurrence of kidney disease
- Rejection of the kidney
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before your procedure and during recovery
Informing your doctor if you are nursing or if there is any possibility of pregnancy
Notifying your doctor immediately of any concerns such as bleeding, fever, or increase in pain
Taking your medications and returning for follow-up care exactly as directed
- Telling all members of your care team if you have any allergies
How do I prepare for my kidney transplant?
You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome.
You can prepare for a kidney transplant by:
Answering all questions about your medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
Losing excess weight before the surgery through a healthy diet and exercise plan
Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Staying in contact with your transplant center as directed and following guidelines for remaining in the area.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.
It is also a good idea to bring a list of questions to your appointments. Questions can include:
Why do I need a kidney transplant? Are there any other options for treating my condition?
How long will the surgery take? When can I go home?
What restrictions will I have after the surgery? When can I return to work? What type of activities and exercises can I perform and when?
What kind of assistance will I need at home?
What medications will I need before and after the surgery? How will these medications affect my lifestyle? What are the risks and complications of these medications?
How will you treat my pain?
What type of tests, regular monitoring, and care will I need after going home?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my kidney transplant?
Knowing what to expect can help make your road to recovery after a kidney transplant as smooth as possible.
How long will it take to recover?
You will move to an intensive care unit (ICU) after surgery. ICUs provide 24-hour specialized monitoring and care.
It may take a few hours until the major effects of anesthesia wear off and you are alert. When you wake up, you may have a breathing tube in your mouth and tubes and wires attached to your body. These allow your team to monitor your vital signs, drain bodily fluids, take blood, and give medications and fluids.
You will not be able to talk if you have a breathing tube. It is usually removed in 24 to 48 hours. You may also have a sore throat. This is usually temporary, but tell your care team if you are uncomfortable.
You will move to a hospital room outside the ICU as you recover. This room will have equipment to monitor your vital signs. A typical hospital stay after a kidney transplant is three to seven days.
Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, type of anesthesia, your general health, age, and other factors.
Your doctor may refer you to a support group program to help you through your recovery process. Full recovery takes eight to 12 weeks.
Will I feel pain?
Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery/procedure. Your doctor will treat your pain so you are comfortable and can get the rest you need. Tell your doctor or care team if your pain gets worse or changes because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after a kidney transplant. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Breathing problems such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Change in alertness such as passing out, dizziness, unresponsiveness, or confusion
Changes in blood pressure. Your transplant team will teach you how to monitor your blood pressure, what your normal blood pressure readings should be, and when to contact the transplant center.
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Inability to urinate or have a bowel movement or prolonged nausea or vomiting
Pain that is not controlled by your pain medication or any discomfort that is new, worsening or different
Painful urination or bloody urine
Swelling, pain, redness, or tenderness around the new kidney
Unexpected drainage, pus, redness or swelling of your incision
Weight gain, which may be a sign that you are retaining fluids. This can be serious.
How might a kidney transplant affect my everyday life?
A kidney transplant may cure your condition or significantly reduce your symptoms so you can lead an active, normal life. However, a kidney transplant can cause significant changes to your body that may affect your everyday life, such as the need to:
Carefully plan any attempt at pregnancy and work closely with all of your healthcare providers before, during and after a pregnancy
Follow a lifelong healthcare plan
Keep follow-up appointments and get routine kidney function testing
Manage lifelong anti-rejection medications and their side effects
Treat other conditions such as diabetes, high blood pressure, and high cholesterol
Watch for signs of rejection
- Work through emotional issues and seek appropriate support
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