What to Expect From a Kidney Transplant

A kidney transplant is a surgical procedure during which a patient receives a donated kidney to replace their diseased kidney. This is done as a treatment for end-stage kidney disease—when one's condition is so severe that it becomes life-threatening.

Reasons for a Kidney Transplant

A healthy human body has two kidneys that work together to filter blood and remove toxins from the body. The kidneys work to maintain the appropriate amount of fluid in the blood and also filter out excess salts, electrolytes, and minerals.

The kidneys make urine with these substances. Urine is then eliminated from the body, first by moving out of the kidneys through the ureters to collect in the bladder, then exiting the body through the urethra during urination.

Without working kidneys, water is not sufficiently eliminated. This can cause fluid overload, which makes it difficult to breathe and causes serious swelling throughout the body. It also puts significant stress on the heart.

When water builds up in the body, it causes disturbances in how much salt, potassium, magnesium, and other electrolytes remain in the blood. Such imbalances can cause issues with heart function and result in other serious complications. 

Diseases and conditions that may result in end-stage kidney disease and warrant a kidney transplant include:

• Diabetes mellitus
• High blood pressure
• Glomerulonephritis
• Polycystic kidney disease
• Severe anatomical problems of the urinary tract

Of American kidney disease patients, 650,000 have end-stage renal disease.

In rare cases, acute renal failure leads to permanent kidney disease. In these cases, the damage is sudden and cannot be reversed. This may happen due to trauma or as a side effect of a major illness.

In the vast majority of surgeries, only one kidney is transplanted, as one is more than capable of filtering the blood of the recipient. If the donated kidneys are very small, both may be transplanted.

Who Is Not a Good Candidate?

There are some issues that typically prevent someone from receiving a transplant. How these are handled may be different from transplant center to transplant center, or even from one surgeon to another.

People with the following health conditions are not considered candidates for a kidney transplant:

• Active infection
• Severe disease of another organ: For some, a multi-organ transplant (e.g., heart-kidney or kidney-pancreas) is available. 
• Active abuse of drugs that may include alcohol, nicotine, and/or illegal drugs
• Body mass index (BMI) above 40
• Cancer that is current or likely to return
• Dementia
• Severe vascular disease
• A life-ending disease in addition to kidney disease
• Severe pulmonary hypertension

Donor Recipient Selection Process

The process to be approved for the transplant list may start when your kidney disease is first noticed and you are referred to a nephrologist (kidney specialist). Your nephrologist may be able to treat your disease for many years, but when it worsens and it becomes clear that dialysis and the need for a transplanted kidney are becoming a reality, you'll be referred to a transplant center. 

Once it is determined that an organ transplant is appropriate, you'll be placed on the transplant list by the center. This means you are added to a national database run by the United Network of Organ Sharing (UNOS) that allows donors and recipients to be matched when an organ becomes available.

The transplant list is actually a very large database of over 112,000 individuals waiting for various types of organ transplants. When an organ becomes available for transplantation, a complex mathematical algorithm is used to create a unique list of the potential recipients for that organ. Thousands of these lists are generated on a monthly basis; each one is unique to a specific organ being donated by a specific donor. 

To give you a sense of the demand for donated kidneys:

• 82% of patients waiting for an organ donation are waiting for a kidney.
• The average wait time for a kidney from a deceased donor is three to five years.

Criteria and Listing Options

Each transplant center has its own criteria that potential recipients must satisfy in order to get on the waitlist. In addition to the potential disqualifying factors listed above, many centers consider other factors such as age, as well as your ability to manage your own health regimen post-surgery.

After meeting with the staff at a transplant center, you will be evaluated. This will include a review of your medical records, blood tests, possible imaging studies, and other tests designed to determine if your condition would benefit from a transplant and that are well enough to tolerate transplant surgery.

When you consider 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 database maintained by the Scientific Registry of Transplant Recipients
• Consider other services provided by the transplant center, such as support groups, travel arrangements, local housing for your recovery period, and referrals to other resources.

You can get on the waiting list at multiple centers, but you may incur additional costs for testing and evaluation. Be aware that because donated organs must be transplanted quickly, matching kidneys first go to local residents, then regional residents, and then are made available nationally.

Types of Donors

Kidneys available for transplant can be donated by living or deceased donors.

• Deceased donor transplant: Most donated organs become available for transplantation when a person suffers brain death and the donor or their family members elect to donate their organs to a waiting recipient.
• Living donor transplant: In some cases, a healthy person can donate a kidney to someone else, as the human body can remain well with one working kidney. This is often a friend or family member. When a living person decides to donate a kidney out of kindness to a waiting recipient they do not know, the donor is referred to as an altruistic donor.

If a loved one wants to donate a kidney, they may or may not be able to do based on their own health. For example, some donors may find out, after starting testing, that they have kidney disease as well. Others may have a health condition that makes the donation too risky. 

Some of the more common issues that prevent living donation include:

• Kidney disease, including some types of kidney stones
• Uncontrolled blood pressure, diabetes, heart disease, or lung disease
• A history of bleeding problems (bleeding too easily or blood clots)
• Poorly controlled psychiatric issues
• Obesity
• Cancer
• Communicable diseases, such as HIV

Compatibility

Not every donor kidney is fit for every person waiting for an organ. In order for a kidney donor and a recipient to match, they must be approximately the same body size. In some cases, a kidney from a child might be appropriate for a small adult female, but would likely not be adequate for a large adult. Similarly, a large kidney would be too big for a young child in need of transplantation. In addition, the two people's blood types must be compatible.

The better the match, the better the outcome from surgery over the long term. A zero antigen mismatch is the technical term for a kidney donor-recipient match that is exceptional. This type of match, which is most often seen between relatives, can reduce the amount of anti-rejection medication the recipient needs in the years after surgery.

Before Surgery

Prior to your actual surgery, you will undergo tests to ensure you are healthy enough to go through with the procedure, including: 

• A chest X-ray
• An electrocardiogram (EKG)
• Blood tests
• A urinalysis
• An assessment of your vital signs, including blood pressure, heart rate, body temperature, and oxygen saturation

As with all pre-operative evaluations, you will be asked to sign a consent form authorizing the surgery and indicating that you understand the risks involved.

Surgical Process

The kidney transplant procedure starts with the donor’s surgery, during which the kidney is removed. Then the process begins for the recipient.

You will first receive general anesthesia and an endotracheal tube. Once you are asleep, the incision is made in the pelvis, just above the waistline on either the right or left side, depending on where the new kidney will be placed.

For most people, the native kidneys—kidneys you were born with—will remain in place unless they are causing circulation problems or other issues that require their removal. This type of operation is called a heterotopic transplant, meaning the kidney is placed in a different location than the existing kidneys.

The artery that carries blood to the kidney and the vein that carries blood away is surgically connected to the artery and vein already existing in the pelvis of the recipient. The ureter, or tube, that carries urine from the kidney is connected to the bladder.

The kidney is sewn into place by one or two surgeons, who take great care to make sure blood flows well through the kidney, and that the kidney begins to make urine within minutes of being connected to the blood supply.

Once the kidney is in place and actively making urine, the surgery is completed and the incision can be closed. The entire process takes two to three hours in most cases.

Complications

In addition to the general risks of surgery and the risks associated with anesthesia, kidney transplant surgery has unique risks. These risks vary from person to person, but also increase with age and the severity of illness. 

Risks of kidney transplant include, but are not limited to:

• Bleeding: The kidney has an extremely high volume of blood flow, so there is the potential for severe blood loss.
• Blood clots
• Stroke
• Acute rejection, in which the recipient's body does not accept the donated kidney
• Death: All surgeries have a risk of death, but the risk is higher than typical with kidney transplantation due to the complex nature of the procedure and care after surgery.

After Surgery

Once your transplant is complete, you will remain in the recovery room, where you will stay until the anesthesia wears off. Your vital signs will be monitored. From there, you will go to the ICU, where your kidney function will be closely monitored for early signs of rejection.

The typical patient returns home within a week of surgery with kidney function that is good enough that dialysis is no longer needed. Most people are able to return to their normal activities within a month or two of surgery. 

You will need regular follow-up visits with your healthcare provider for a year after your transplant. In the first few weeks, you'll go twice a week for lab work and a check-up; after one year, you'll go every three to four months.

Organ rejection can be a serious issue after transplant surgery. This occurs when the body identifies the new organ as a foreign body and tries to reject it. To prevent this, you will be on immunosuppressant medications (calcineurin inhibitors) indefinitely.

Rejection episodes are most common in the six months after surgery but are possible at any time after a transplant. The faster rejection is identified and treated, the better the outcome. According to UNOS:

• One out of 10 patients will have rejection symptoms.
• 4% of patients will lose their kidney in the first year due to rejection.
• 21% of patients will lose their kidney in the first five years due to rejection.

Prognosis

Some patients experience immediate kidney function that is excellent, while others have a delay in kidney function that may make dialysis a necessity until the kidney reaches its full potential. In rare cases, the kidney never works well enough to allow the patient to stop having dialysis treatments.

That said, after receiving a healthy kidney, a patient is up to seven times less likely to die than when they were on dialysis. Whether they received an organ from a living or deceased donor, 90% of patients are alive three years after surgery. At 10 years after surgery, 81% of deceased donor recipients and 90% of living donor recipients are alive.

Support and Coping

Going through the experience of receiving an organ transplant can be overwhelming and stressful every step of the way. Over the course of what may be years before you are living a healthy life with your new kidney, you'll no doubt experience ups and downs.

Fortunately, there are many resources you can tap to help get you through the emotional aspects of the transplant process. In addition to seeking support from your friends and family, you might want to look into:

• Support groups: Your transplant team will include a social worker, who can point you in the direction of in-person and online support groups consisting of other people who are going through the transplant process or are in the post-transplant stage. UNOS's website also offers some listings.
• Mental health providers: It's normal to feel anxious, depressed, or worried about your future before, during, and after a kidney transplant. If you have a pre-existing mental health condition, it can be even more challenging. Again, your transplant team can help you get in touch with an appropriate mental health professional if necessary.

Try to go easy on yourself during this process by setting realistic goals and expectations as you go forward. Life after a kidney transplant will take some time to adjust to, and you want to avoid any undue stress.

Diet and Nutrition

Keeping yourself healthy after a kidney transplant is as important as it was before the surgery. Furthermore, some of the medications you'll need to take can lead to weight gain, as well as elevated blood pressure, blood sugar, cholesterol, and potassium levels and lower levels of important minerals.

A dietitian on your transplant team can help you learn how to manage your weight, maintain healthy blood pressure and blood sugar levels, and keep the proper balance of blood components and minerals.

Some of these measures will help:

• Limit high-calorie, sugary, and fatty foods: Instead, focus on foods high in fiber, such as vegetables and fruits; lean meats and fish; lowfat or nonfat dairy products; and unsweetened beverages.
• Limit salt, which is found in many processed meats, snack foods like chips and pretzels, canned foods, and some sports drinks.
• Get enough protein from healthy sources such as lean meats, fish, eggs, beans, and peanut butter. You may need more protein than normal right after your transplant to repair and rebuild muscle tissue and help you heal.
• Talk to your dietitian about how best to manage your potassium, calcium, and phosphorus levels; calcium and phosphorus, in particular, are important to prevent bone loss, which can occur as a result of illness.
• Drink adequate amounts of water and other fluids each day.
• Know what to avoid: Stay away from grapefruit, grapefruit juice, and pomegranates, as they can have a negative effect on a group of immunosuppressive medications.

Exercise

Once you've healed from your surgery, it's important to begin, or resume, an exercise plan. Getting regular exercise is important for maintaining a healthy weight, controlling blood pressure, and increasing muscle strength.

Your transplant team can help you come up with a plan that's right for you, but in general you should:

• Err on the side of caution and start with 10 minutes a day of exercise, working up to around 30 minutes three to five days per week.
• Do both aerobic exercise, such as walking, biking, or swimming for heart health and weight control, and resistance or weight training to regain muscle function and strength.

Keep in mind that immunosuppressants can make you more susceptible to getting a sunburn, so use sunscreen and wear a hat if you exercise outside. If you work out in a gym, wipe down the equipment with a disinfectant to avoid being exposed to any contagious bacteria or viruses.

And always listen to your body. If you experience any type of discomfort, breathing difficulties, or significant fatigue, stop exercising immediately and contact your healthcare provider.

A Word From Verywell

A kidney transplant is a complex and serious surgery that can take months of preparation, testing, and frequent healthcare provider visits just to turn around and wait for years for an organ to become available.

For most, the frequent dialysis treatments and all of the time spent wondering and waiting if an organ will become available is worth it. Transplant surgery can lead to a dramatic change in the feelings of fatigue and exhaustion that come with dialysis and kidney disease and make for a healthier and happier life.