Kidney Transplant

A surgical procedure to remove a severely diseased and damaged kidney and replace it with a healthy kidney from a donor. The donor may be a living relative, a close friend whose tissue closely matches yours, or someone who has died and donated his or her organs.

Parts of the Body Involved

Kidney, blood vessels, ureters

Reasons for Procedure

A kidney transplant is done to treat irreversible, end-stage kidney diseases. The procedure is most often performed when the kidneys fail for the following reasons:
  • Diabetes
  • High blood pressure that destroys the kidneys
  • Glomerulonephritis (a kidney disorder)
  • Polycystic kidney disease
  • Damage from severe pyelonephritis (inflammation in the kidney, often due to bacterial infection)

Risk Factors for Complications during the Procedure

  • Pre-existing medical conditions, especially certain heart, lung, and/or liver diseases
  • Autoimmune disease
  • Age extreme (young or old), of either the recipient or the donor
  • Difference in race between the recipient and donor
  • Prior blood transfusion
  • Prior failed transplant
  • Pregnancy
  • Conditions that will likely result in a recurrence of kidney failure in the new kidney
  • Cancer
  • Certain infections, such as osteomyelitis, tuberculosis, hepatitis

What to Expect

Prior to Procedure

Because of a shortage or donors, you may be on a transplant list for some time. You may need to carry a pager or cellular phone at all times so that the transplant team can reach you if a donor kidney becomes available.

Your doctor will likely do the following:
  • Physical exam
  • Review of medications
  • Blood tests
  • Electrocardiogram (ECG, EKG) - a test that records the heart's activity by measuring electrical currents through the heart muscle
  • Chest x-ray
  • Extensive tissue typing
You may be asked to undergo psychological testing and counseling to ensure that you are well-prepared for the stress of this procedure.

The days leading up to your procedure:
  • Continue renal dialysis as directed by your doctor
  • Take medications as directed and do not take over-the-counter medications without checking with your doctor
  • The night before, eat a light meal and do not eat or drink anything after midnight unless told otherwise by your doctor
  • Arrange for help at home after returning from the hospital
During Procedure - IV fluids, antibiotics, anesthesia

Anesthesia - General

Description of the Procedure - The surgeon cuts into the lower abdomen and connects the donated kidney to your arteries, veins, and ureter, which carries urine to the bladder. The diseased kidneys are usually left in place. The incision is closed. Your new kidney may start producing urine immediately or within a short time.

After Procedure - A catheter in your bladder that is connected to a bag collecting urine

How Long Will It Take? 3-6 hours

Will It Hurt? Anesthesia prevents pain during surgery. You may experience pain while recovering, but you will receive pain medication to relieve this discomfort.

Possible Complications:
  • Infection
  • Rejection of the new kidney
  • Leakage from ureter
  • Heart disease
  • Blood clot in the bladder or vein connected to the kidney
  • Post-operative diabetes
  • Gastrointestinal ulcers (sores in the lining of the stomach or intestines)
  • Phlebitis (blood clots of a vein)
  • Excessive swelling or bleeding
  • Damage to blood vessels or nerves
  • Severe infections or cancer related to long-term use of immunosuppressive medications
Average Hospital Stay: 1-2 weeks

Postoperative Care:
  • Take deep breaths and cough 10 to 20 times every hour to decrease the risk of fluid building up in your lungs and pneumonia
  • Expect to get out of bed the day after surgery
  • You will be started on drugs to suppress your immune function and therefore decrease the risk that your body will reject your new kidney
  • You may be given steroid medications to decrease inflammation in your new kidney
  • You may be given diuretic medications to help rid your body of accumulated fluid
  • Only take medications approved by your doctor
  • Your new kidney may be monitored via ultrasound examinations and nuclear medicine scans
  • You may be asked to weigh yourself and take your blood pressure daily, and to measure the amount of fluids you take in as well as the amount of urine you pass
  • The amount of salt and protein you eat may be restricted
  • You may be asked to avoid alcohol for at least a year

Outcome

After a period of recuperation, you will most likely be able to return to work and normal activities.

To reduce the chance that your body will reject the donor kidney, you will need to take immunosuppressive drugs for the rest of your life. Additional drugs may be ordered to manage side effects. These drugs may increase your risk of developing cancer, kidney disease (in the new kidney), and weak bones.

More than 80% of transplanted kidneys from cadaver donors remain working after one year. The success rate often improves with a kidney from a living donor, because the donated tissue usually more closely matches your tissue.

Call Your Doctor If Any of the Following Occurs

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
  • Cough, shortness of breath, chest pain, or severe nausea or vomiting
  • Pain, burning, urgency, frequency of urination, or persistent bleeding in the urine
  • Passing no or only small amounts of urine
  • Pain and/or swelling in your feet, calves, or legs, or sudden shortness of breath or chest pain
  • Coughing up blood
  • Sudden headache or feeling faint
  • Malaise
  • High blood pressure
  • Weight gain greater than three pounds in one day