Kidney Transplant

by Editorial Staff and Contributors

Definition

Kidney transplant is a Surgery to place a donor kidney in the body. The new kidney will take over the job of the damaged kidneys. The kidney may come from a living donor or from someone who has died.

Normal Anatomy of the Kidney

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Reasons for Procedure

A kidney transplant is a treatment option for people who have kidney failure. Kidneys perform vital work for the body. If they cannot work as needed it can lead to severe illness and death. The donor kidney can take over the work that the damaged kidneys can’t do.

A transplant may also be done in people who had both kidneys removed.

Possible Complications

Your doctor will review potential problems. Potential problems from the transplant surgery may include:

  • Infection
  • Bleeding
  • Urinary/ureteral obstruction
  • Urine leakage into the body
  • Blood clot in kidney
  • Damage to kidney blood vessels or nerves
  • Damage to nearby organs
  • Heart attack

The immune system can attack the new kidney since it is foreign tissue. Medicine will be needed to decrease this reaction. Problems due to the immune system or medicine used to treat it can develop later. They may include:

  • Rejection of the new kidney which can lead to failure of the transplant
  • Side effects of immune suppressive medications including:
    • Infection by common bacteria
    • Infection from unusual causes such as viruses and fungi
    • Development of certain cancers, especially skin cancer and blood/lymphatic cancers

Some factors that may increase the risk of complications include:

  • Smoking
  • Pre-existing medical conditions, especially certain heart, lung, and liver diseases
  • Autoimmune disease
  • Current infection
  • HIV infection
  • Young age or increased age—of either you or the donor
  • Poorly matching tissue between you and the donor
  • Prior failed transplant
  • Pregnancy
  • Conditions that may lead to kidney failure in the new kidney
  • Cancer

What to Expect

Prior to Procedure

There is a shortage of donors. You may be on a transplant list for some time. You may need to carry a cell phone with you at all times. This will allow the transplant team to reach you if a kidney becomes available.

Testing before the surgery may include:

  • Blood tests, including blood chemistries, liver function tests, bleeding profile, and infection testing
  • Extensive tissue testing
  • Electrocardiogram (EKG)
  • Cardiac stress test
  • Echocardiogram
  • Cancer screening including:
  • Chest x-ray
  • Psychological testing and counseling—to help you to be prepared for the transplant

Leading up to your procedure:

  • Continue dialysis as instructed by your doctor.
  • Talk to your doctor about any medicine you are taking. You may be asked to stop taking some medicine up to one week before the procedure.
  • Take medicine as directed. Do not take over-the-counter medicine without checking with your doctor.
  • Eat a light meal the night before. Do not eat or drink anything after midnight.
  • Arrange for someone to drive you home. Also, arrange for someone to help you at home.

Anesthesia

General anesthesia will be used. You will be asleep during the procedure.

Description of the Procedure

An incision will be made in the lower belly. The donated kidney will be connected to blood vessels. Blood flow can then pass to the new kidney. The tube that carries the urine to the bladder will also be attached.

The diseased kidney will often be left in place. It may need to be removed if it is causing problems. It may also be removed if more room is needed. The surgeon will close tissue at the incision. The new kidney may start making urine right away or within a short time.

Immediately After Procedure

Recovery will start in the intensive care unit (ICU). Care will include:

  • Breathing tube until you can breathe on your own
  • IV fluids and medicine
  • Bladder catheter to drain urine

How Long Will It Take?

About 3-6 hours

How Much Will It Hurt?

Anesthesia will prevent pain during surgery. There will be discomfort after the procedure. Medicine will help to manage pain until you have healed.

Average Hospital Stay

The usual length of stay is 1 to 2 weeks. Your doctor may choose to keep you longer if you have problems.

Post-procedure Care

At the Hospital

While you are recovering at the hospital, you will need to:

  • Get out of bed. Often starts the day after surgery.
  • Breathe deeply and cough 10-20 times every hour. This will help your lungs work better after surgery.
  • Take medicine to decrease your immune system. This medicine will need to be continued for the rest of your life. It will reduce the chance that your body will reject the new kidney.
  • Wear special stockings. They may reduce the risk of blood clots that can form with bed rest.

The new kidney may help you feel better overall. Many will start to feel better within the first few days.

At Home

Your new kidney will need to be monitored. Your doctor may ask you to check your weight and urine output. You will need to go to regular doctor visits and tests to make sure the kidney is working well. It is also important to let your doctor know if you have changes in urine output, weight, or signs of rejection.

Pressure to the new kidney will need to avoided. Some activity will be limited. Driving will also be banned until your doctor has cleared you.

There will be some limits to your diet but not as many as you had for dialysis.

Call Your Doctor

It is important for you to monitor your recovery after you leave the hospital. Alert your doctor to any problems right away. If any of the following occur, call your doctor:

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
  • Passing no or only small amounts of urine
  • Pain, burning, urgency, frequency of urination, or persistent bleeding in the urine
  • Vomiting, black or tarry stools, diarrhea, or constipation
  • Abdominal pain or cramping
  • Sore throat or mouth sores
  • Cough, shortness of breath, or any chest pain
  • Coughing up blood
  • Severe headache
  • Headache, confusion, lightheadedness, or loss of consciousness
  • Pain and/or swelling in your feet, calves, or legs
  • Weight gain greater than 3 pounds in one day

If you think you have an emergency, call for medical help right away.

RESOURCES:

National Institute of Diabetes and Digestive and Kidney Diseases
http://www.niddk.nih.gov
Urology Care Foundation
http://www.urologyhealth.org

CANADIAN RESOURCES:

Kidney Cancer Canada
http://www.kidneycancercanada.ca
The Kidney Foundation of Canada
http://www.kidney.ca

References:

Akbar SA, Jafri ZH, Amendola MA, et al. Complications of renal transplantation. RadioGraphics. 2005;25(5):1335-1356.
Chronic kidney disease (CKD) in adults. EBSCO DynaMed Plus website. Available at: http://www.dynamed... . Updated August 23, 2016. Accessed August 29, 2017.
Greco F, Fornara P, Mirone V. Renal transplantation: technical aspects, diagnosis and management of early and late urological complications. Panminerva Med. 2014 Mar;56(1):17-29.
Immunosuppression in kidney transplantation. EBSCO DynaMed Plus website. Available at: http://www.dynamed... . Updated July 24, 2017. Accessed August 29, 2017.
Kidney transplant. National Kidney Foundation website. Available at: https://www.kidney.org/atoz/content/kidneytransnewlease. Updated January 26, 2017. Accessed August 29, 2017.
Kidney (renal) transplantation.Urology Care Foundation website. Available at:
...(Click grey area to select URL)
Updated January 2011. Accessed August 29, 2017.
11/30/2010 DynaMed Plus Systematic Literature Surveillance http://www.dynamed... : Stock PG, Barin B, Murphy B, et al. Outcomes of kidney transplantation in HIV-infected recipients. N Engl J Med. 2010;363(21):2004-2014.
6/2/2011 DynaMed's Systematic Literature Surveillance http://www.dynamed... : Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.
Last reviewed September 2018 by EBSCO Medical Review Board Michael Woods, MD, FAAP
Last Updated: 9/30/2013

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