What to Expect From a Kidney Transplant

How to Get on the Kidney Transplant List

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, which refers to kidney disease that is so severe that it will shorten the lifespan of the individual because the kidneys are no longer able to do their job well enough to prevent illness.

Reasons for a Kidney Transplant

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

The kidneys make urine with what is filtered from the blood. This 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 the kidneys, water is not eliminated from the body, which can cause fluid overload making it difficult to breathe and causing serious swelling throughout the body. It also makes the work of the heart much more difficult, and if it continues without treatment, this excess water can lead to death. Along with the excess water comes disturbances in how much salt, potassium, magnesium, and other electrolytes remain in the blood. Imbalances in these substances can cause issues with the function of the heart and other serious complications. 

People whose kidneys are no longer functioning well enough to support the needs of their body will need dialysis or a kidney transplant to prevent death. 

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

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 a trauma or as a side effect of a major illness. 

Who Is Not a Good Candidate?

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

People with the following issues are not candidates for a kidney transplant:

  • Active infection
  • Severe disease of another organ (for some a multi-organ transplant is available, including a heart-kidney or a kidney-pancreas) 
  • Active addiction to drugs that may include illegal drugs, alcohol, and/or nicotine
  • Cancer that is current, or likely to return
  • Inability to manage their own health regimen 
  • Dementia
  • Severe vascular disease
  • A life-ending disease in addition to kidney disease
  • Severe pulmonary hypertension

Donor Recipient Selection Process

The process of being listed on the transplant recipient wait list is neither quick nor easy, but the effort is well worth it when a new kidney becomes available.

The process to be approved to be on the transplant list will start early in the disease process, when your kidney problem is first noticed, and a referral to a nephrologist—kidney doctor—is made. 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 the patient is determined to be appropriate for an organ transplant, they are placed on the transplant list by the transplant center. This means they 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 114,000 individuals waiting for a variety of types of organ transplants. When an organ becomes available for transplantation, a complex mathematical algorithm is used to create the 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. 

Each transplant center has its own criteria that potential recipients must satisfy in order to get on the waitlist. You can get on the waiting list at multiple centers, but remember you may incur additional costs for testing and evaluation. Be aware that 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 becomes brain dead, and the donor or their family members elect to donate their organs to a waiting recipient. This type of donation is called a deceased donor transplant.

Living Donor Transplant

In some cases, a healthy friend or family member will donate a kidney to a loved one, as the human body can remain well with one healthy kidney. This is called a living donor. When a living person decides to donate a kidney to a waiting recipient they do not know out of kindness, the donor is referred to as an altruistic donor.

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 not be adequate for a large adult, depending on the size of the child. 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.

If a loved one wants to donate a kidney, they may or may not be able to do so for a wide variety of reasons. Some donors may find out, after starting testing, that they have kidney disease too. Others find out that they have the wrong blood type or 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. This is a particular risk when siblings are donating to a sibling with kidney disease; the donating sibling may also find out they have kidney disease.
  • Uncontrolled blood pressure, diabetes, heart disease or lung disease
  • History of bleeding problems: bleeding too easily or blood clots
  • Poorly controlled psychiatric issues
  • Obesity
  • Cancer
  • Communicable diseases, such as HIV

The better that 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.

In 2017, 92,685 patients were on the waiting list for a donated kidney. The wait for a deceased donor kidney can be anywhere from five to 10 years.

Before Surgery

Before you undergo the actual transplant, you will have to choose a transplant center. Seeing a transplant surgeon requires a referral from your own physician to the transplant center that performs kidney transplants near your home. In many cases, there may only be one nearby, but in large cities, you may have multiple options. The referral is typically made by your nephrologist, but a referral can also be made by primary care and other specialists involved in your treatment.

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 you are well enough to tolerate transplant surgery but sick enough to need a new organ.

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.

Once a donor kidney becomes available, it must be transplanted into a recipient within 24 to 36 hours. You should keep a packed hospital bag handy and make arrangements for transportation to the transplant center in advance. Make sure the transplant team knows how to reach you at all times.

Surgical Process

The kidney transplant procedure starts with the donor’s surgery, during which the kidney is removed. Once the kidney is determined to be healthy and of high enough quality to be transplanted into a recipient, the process begins for the recipient. They will be sent to the hospital where preparations are made for surgery.

The patient will receive general anesthesia and an endotracheal tube. Once the patient is 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 the patient was 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, with 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.

In the vast majority of surgeries, only one kidney is transplanted as one kidney is more than capable of filtering the blood of the recipient. If the donated kidneys are very small, both may be transplanted into the recipient to make sure that the kidneys are able to filter well enough to keep the recipient well.

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 flow.
  • Blood clots
  • Stroke
  • 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.
  • Acute rejection, in which the donor's body does not accept the donated kidney

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. 

Some patients experience immediate kidney function that is excellent, 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.

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 indefinitely.

Rejection episodes are most common in the six months after surgery but are possible at any time after transplant surgery. When rejection happens, the faster it is identified and treated the better the outcome.

Prognosis

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

It's normal to feel anxious or overwhelmed while waiting for a transplant or to have fears about rejection, returning to work, or other issues after a transplant. Seeking the support of friends, family members, and your transplant team can help you cope during this stressful time.

Your transplant team also can assist you with other useful resources and coping strategies throughout the transplant process, such as:

  • Joining a support group for transplant recipients: Talking with others who have shared your experience can ease fears and anxiety.
  • Getting mental health treatment: If you're depressed, talk to your doctor. He or she may recommend medications or refer you to a mental health professional.
  • Finding rehabilitation services: If you're returning to work, your social worker may be able to connect you with rehabilitation services.
  • Setting realistic goals and expectations: Recognize that life after a kidney transplant may not be exactly the same as life before a transplant. Having realistic expectations about results and recovery time can help reduce stress.
  • Educating yourself: Read as much as you can about your procedure and ask questions about things you don't understand. Knowledge is empowering.

Diet and nutrition

After your kidney transplant, you should adjust your diet to keep your lungs healthy and functioning well. Maintaining a healthy weight with diet and exercise can help prevent many common post-transplant complications, including infection, heart attacks, and bone thinning.

Your transplant team should include a nutrition specialist (dietitian) who can discuss your nutrition and diet needs and answer any questions you have after your transplant. Your dietitian's recommendations may include:

  • Eating at least five servings of fruits and vegetables each day
  • Eating lean meats, poultry and fish
  • Eating whole-grain breads, cereals and other products
  • Having enough fiber in your daily diet
  • Drinking low-fat milk or eating other low-fat dairy products to help maintain healthy calcium levels
  • Limiting salt and sodium intake by using fresh herbs and spices to season foods and avoiding processed foods
  • Limiting unhealthy fats, such as saturated fats in butter and red meats
  • Limiting your caffeine and avoiding excessive alcohol intake
  • Staying hydrated by drinking adequate water and other fluids each day
  • Avoiding grapefruit and grapefruit juice, pomegranate and Seville oranges due to their effect on a group of immunosuppressive medications called calcineurin inhibitors
  • Following food safety practices to reduce the risk of infection

Exercise

Exercise and physical activity should be a regular part of your life after a kidney transplant to continue improving your overall physical and mental health. Regular exercise helps boost energy levels and increase strength. It also helps you maintain a healthy weight, reduce stress, and prevent common post-transplant complications such as high blood pressure and cholesterol levels.

Your transplant team will recommend a physical activity program based on your individual needs and goals.

Walking, bicycling, swimming, low-impact strength training, and other physical activities you enjoy can all be a part of a healthy, active lifestyle after transplant. But be sure to check in with your transplant team before starting or changing your post-transplant exercise routine.

A Word From Verywell

A kidney transplant is a complex and serious surgery that can take months of preparation, testing, and frequent doctor 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 absolutely worth it when a kidney becomes available. Transplant surgery leads to a dramatic change in the feelings of fatigue and exhaustion that come with dialysis and kidney disease, a change that is often notable and dramatic even before leaving you leave the hospital.

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