What Is a Kidney Transplant?
A kidney transplant is a surgical procedure that’s done to treat kidney failure. The kidneys filter waste from the blood and remove it from the body through your urine. They also help maintain your body’s fluid and electrolyte balance. If your kidneys stop working, waste builds up in your body and can make you very sick.
People whose kidneys have failed usually undergo a treatment called dialysis. This treatment mechanically filters waste that builds up in the bloodstream when the kidneys stop working. Some people whose kidneys have failed may qualify for a kidney transplant, in which one or both kidneys are replaced with donor organs from a live or deceased person.
There are pros and cons to both dialysis and kidney transplants. Undergoing dialysis takes time and is labor-intensive. Dialysis often requires making frequent trips to a dialysis center to receive treatment. At the dialysis center, your blood is cleansed using a dialysis machine. If you decide to have dialysis in your home, you’ll need to purchase dialysis supplies and learn how to use them.
A kidney transplant can free you from a lifelong dependence on a dialysis machine and the strict schedule that goes with it. This can allow you to live a more active life. However, kidney transplants aren’t suitable for everyone, including those with active infections and those who are severely overweight.
During a kidney transplant, your surgeon will take a donated kidney and place it in your body. Even though you’re born with two kidneys, you can lead a healthy life with only one functioning kidney. After the transplant, you’ll have to take immune-suppressing medications to keep your immune system from attacking the new organ.
Who Might Need a Kidney Transplant?
A kidney transplant may be an option if your kidneys have stopped working entirely. This condition is called end-stage renal disease (ESRD) or end-stage kidney disease (ESKD). If you reach this point, your doctor is likely to recommend dialysis.
In addition to putting you on dialysis, your doctor will tell you if they think you’re a good candidate for a kidney transplant. You’ll need to be healthy enough to have major surgery and tolerate a strict, lifelong medication regimen after surgery to be a good candidate for a transplant. You must also be willing and able to follow all instructions from your doctor and take your medications regularly.
If you have a serious underlying medical condition, a kidney transplant might be dangerous or unlikely to be successful. These serious conditions include:
- cancer, or a recent history of cancer
- serious infection, such as tuberculosis, bone infections, or hepatitis
- severe cardiovascular disease
- liver disease
Your doctor may also recommend that you don’t have a transplant if you:
- drink alcohol in excess
- abuse drugs
If your doctor thinks you’re good candidate for a transplant, and you’re interested in the procedure, you’ll need to be evaluated at a transplant center. This evaluation usually involves several visits to assess your physical, psychological, and familial condition. The doctors will run tests on your blood and urine and give you a complete physical exam to ensure you’re healthy enough for surgery.
A psychologist and a social worker will also meet with you to make sure you’re able to understand and follow a complicated treatment regimen. The social worker will make sure you can afford the procedure and that you have adequate support after you’re released from the hospital.
If you’re approved for a transplant, either a family member can donate a kidney or you’ll be placed on a waiting list with the Organ Procurement and Transplantation Network (OPTN). The typical wait for a deceased donor organ is over five years.
Who Donates the Kidney?
Kidney donors may be either living or deceased.
Because the body can function perfectly well with just one healthy kidney, a family member with two healthy kidneys may choose to donate one of them to you. If your family member’s blood and tissues match your blood and tissues, you can schedule a planned donation. Receiving a kidney from a family member is a good option because it reduces the risk that your body will reject the kidney and it enables you to bypass the multi-year waiting list for a deceased donor.
Deceased donors are also called cadaver donors. These are people who have died, usually as the result of an accident rather than a disease. Either the donor or their family has chosen to donate their organs and tissues. Kidneys from an unrelated donor are more likely to be rejected by your body. However, a cadaver organ is a good alternative if you don’t have a family member or friend who is willing or able to donate a kidney.
The Matching Process
During your evaluation for a transplant, you’ll have blood tests to determine your blood type (A, B, AB, or O) and your human leukocyte antigen (HLA). HLA is a group of antigens located on the surface of your white blood cells. Antigens are responsible for your body’s immune response. If your HLA type matches the donor’s HLA type, it’s more likely that your body will not reject the kidney. Each person has six antigens, three from each biological parent. The more antigens you have that match those of the donor, the greater the chance of a successful transplant.
Once a potential donor has been identified, you’ll need another test to make sure that your antibodies won’t attack the donor’s organ. This is done by mixing a small amount of your blood with the donor’s blood.
The transplant can’t be done if your blood forms antibodies in response to the donor’s blood. You have what is called a “negative crossmatch” if your blood shows no antibody reaction. This means that the transplant can proceed.
How Is a Kidney Transplant Performed?
Your doctor can schedule the transplant in advance if you’re receiving a kidney from a living donor. However, if you’re waiting for a deceased donor who’s a close match for your tissue type, you’ll have to be available to rush to the hospital at a moment’s notice when a donor is identified. Many transplant hospitals give their people pagers or cell phones so that they can be reached quickly.
Once you arrive at the transplant center, you’ll need to give a sample of your blood for the antibody test. You’ll be cleared for surgery if the result is a “negative crossmatch.”
A kidney transplant is done under general anesthesia. This involves giving you a medication that puts you to sleep during the surgery. The anesthetic will be injected into your body through an intravenous (IV) line in your hand or arm.
Once you’re asleep, your doctor makes an incision, or cut, in your abdomen and places the donor kidney inside. Your doctor then connects the arteries and veins from the kidney to your arteries and veins. This will cause blood to start flowing through the new kidney. The doctor will also attach the new kidney’s ureter to your bladder so that you’ll be able to urinate normally. The ureter is the tube that connects your kidney to your bladder.
Your doctor will leave your original kidneys in your body unless they’re causing problems such as high blood pressure or infection.
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You’ll wake up in a recovery room where hospital staff will monitor your vital signs until they’re sure you’re awake and stable. Then, they’ll transfer you to a hospital room. Even if you feel great after your transplant (many people do), you’ll likely need to stay in the hospital for up to a week after surgery.
Your new kidney may start to clear waste from the body immediately, or it may take up to a few weeks before it starts functioning. Kidneys donated by family members usually start working more quickly than those from unrelated or deceased donors.
You can expect a good deal of pain and soreness near the incision site while you’re first healing. While you’re in the hospital, your doctors will monitor you for complications. They’ll also put you on a strict schedule of immunosuppressant drugs to stop your body from rejecting the new kidney. You’ll need to take these drugs every day for the rest of your life.
Before you leave the hospital, your transplant team will give you specific instructions on how and when to take your medications. Make sure that you understand these instructions and that you follow them exactly. Your doctors will also create a checkup schedule for you to follow after surgery.
Once you’re discharged, you’ll need to keep regular appointments with your transplant team so that they can evaluate how well your new kidney is functioning. You’ll need to take your immunosuppressant drugs as directed. You’ll also be prescribed additional drugs to reduce the risk of infection. Finally, you’ll need to monitor yourself for warning signs that your body has rejected the kidney. These include pain, swelling, and flu-like symptoms.
You’ll need to follow up regularly with your doctor for the first one to two months after surgery. Your recovery may take about six months.
What Are the Risks of a Kidney Transplant?
A kidney transplant is a major surgery. Therefore, it carries the risk of:
- an allergic reaction to general anesthesia
- blood clots
- a leakage from the ureter
- a blockage of the ureter
- an infection
- rejection of the donated kidney
- failure of the donated kidney
- a heart attack
- a stroke
The most serious risk of a transplant is that your body rejects the kidney. However, it’s rare that your body will reject your kidney. The Mayo Clinic estimates that 90 percent of transplant recipients who get their kidney from a living donor live for at least five years after surgery. About 82 percent of those who received a kidney from a deceased donor live for five years afterward.
If you notice unusual soreness at the incision site or a change in the amount of your urine, let your transplant team know right away. If your body does reject the new kidney, you can resume dialysis and go back on the waiting list for another kidney after being evaluated again.
The immunosuppressant drugs you must take after the surgery can lead to some unpleasant side effects. These may include:
- weight gain
- bone thinning
- increased hair growth
- a higher risk of developing certain skin cancers and non-Hodgkin lymphoma
Talk to your doctor about your risks of developing these side effects.