• Kidney Transplant

    Definition

    A kidney transplant is a surgery to replace a diseased or damaged kidney with a donor kidney. The donor may be a relative or friend. The donor can also be someone who has died and donated the organs.
    Anatomy of the Kidney
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    Copyright © Nucleus Medical Media, Inc.

    Reasons for Procedure

    A kidney transplant is done to replace a kidney that is no longer working and cannot be fixed. It may also be done if the kidney has been removed (eg, as cancer treatment). A kidney transplant is only needed if both kidneys are not working. Kidneys fail due to:
    More than 90% of transplanted kidneys from deceased donors remain working after one year. The success rate is higher with a kidney from a living donor.

    Possible Complications

    If you are planning to have a kidney transplant, your doctor will review a list of possible complications. These may include:
    • Infection
    • Bleeding
    • Rejection of the new kidney
    • Urine leakage into the body
    • Blood clot
    • Damage to blood vessels or nerves
    • Damage to nearby organs
    • Urinary obstruction
    • Cancer risk due to prolonged use of immunosuppressive drugs
    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
    • Extreme age (young or old) of either you or the donor
    • Poorly matching tissue between you and the donor
    • Prior failed transplant
    • Pregnancy
    • Conditions that will likely result in a recurrence of kidney failure in the new kidney
    • Cancer
    Be sure to discuss these risks with your doctor before the surgery.

    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.
    Your doctor will likely do the following:
    • Physical exam
    • Review of medicines
    • Blood tests, including blood chemistries, liver function tests, bleeding profile, and infection testing
    • Extensive tissue typing
    • Electrocardiogram (ECG, EKG) —a test that records the heart's activity by measuring electrical currents through the heart muscle
    • Chest x-ray —a test that uses radiation to take a picture of structures inside the chest
    • Psychological testing and counseling—to help you to be prepared for the transplant
    Leading up to your procedure:
    • Continue dialysis as directed by your doctor.
    • Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
      • Anti-inflammatory drugs, such as aspirin
      • Blood thinners, such as clopidogrel or warfarin
    • Take medicines as directed. Do not take over-the-counter medicines 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. It will block any pain and keep you asleep through the surgery. It is given through an IV in your hand or arm.

    Description of the Procedure

    The doctor will cut into the lower abdomen. The donated kidney will be connected to your arteries, veins, and ureter (tube that carries the urine to the bladder). In most cases, the diseased kidneys will be left in place. The doctor will then close the incision. The new kidney may start producing urine right away or within a short time.

    Immediately After Procedure

    You will have a catheter left in your bladder. This catheter will be connected to a bag to collect urine.

    How Long Will It Take?

    3-6 hours

    How Much Will It Hurt?

    You will have pain during the recovery process. Your doctor will give you pain medicine.

    Average Hospital Stay

    This procedure is done in a hospital setting. The usual length of stay is 1-2 weeks. Your doctor may choose to keep you longer if you have complications.

    Post-procedure Care

    At the Hospital
    While you are recovering at the hospital, you will need to:
    • Get out of bed the day after surgery.
    • Breathe deeply and cough 10-20 times every hour—This will help your lungs work better after surgery.
    • Take immunosupressive drugs—You will need to take these for the rest of your life. These drugs reduce the chance that your body will reject the new kidney.
    At Home
    When you return home, do the following to help ensure a smooth recovery:
      Take medicine as advised by your doctor, which may include:
      • Steroid medicines to decrease swelling in the new kidney
      • Diuretic medicines to help rid your body of built up fluid
    • Your new kidney needs to be monitored. Have tests and exams done as directed.
    • Weigh yourself daily. Also, measure the amount of fluids you take in and the amount of urine you pass.
    • Restrict the amount of salt and protein that you eat.
    • If advised by your doctor, avoid alcohol for at least one year.
    • Ask your doctor about when it is safe to shower, bathe, or soak in water.
    • Be sure to follow your doctor’s instructions .
    After the recovery process, you may be able to return to work and normal activities.

    Call Your Doctor

    After you leave the hospital, contact your doctor if any of the following occurs. In case of an emergency, call for medical help right away.
    • 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, or 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, dizziness, light-headedness, or loss of consciousness
    • Pain and/or swelling in your feet, calves, or legs
    • Weight gain greater than three pounds in one day
    In case of an emergency, call for medical help right away.

    RESOURCES

    Urology Care Foundation http://www.urologyhealth.org/

    National Kidney and Urologic Diseases Information Clearinghouse http://kidney.niddk.nih.gov/

    National Kidney Foundation http://www.kidney.org/

    CANADIAN RESOURCES

    Kidney Cancer Canada http://www.kidneycancercanada.ca

    The Kidney Foundation of CanadaNorthern Alberta and the Territories Branch http://www.kidney.ab.ca/

    References

    Akbar SA, Jafri ZH, Amendola MA, et al. Complications of renal transplantation. RadioGraphics. 2005; 25: 1335-1356.

    Halloran PF. Immunosuppressive drugs for kidney transplantation. NEJM. 2004; 351: 2715-2729.

    Kidney transplant. National Kidney Foundation website. Available at: http://www.kidney.org/atoz/content/kidneytransnewlease.cfm . Accessed December 13, 2012.

    Kidney (renal) transplantation. American Urological Association Foundation website. Available at: http://www.urologyhealth.org/adult/index.cfm?cat=08&topic=123 . Updated January 2011. Accessed December 13, 2012.

    11/30/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : 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 DynaMed's Systematic Literature Surveillance : 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.e8.

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