Kidney transplant

Surgery Overview

A kidney transplant is surgery to replace your own diseased kidneys with a healthy (donor) kidney. See an illustration of a kidney transplant . There are two types of donors:

• Living donors. A living donor may be a family member, a friend, a coworker, or any person who is willing to give a kidney to someone in need. A person only needs one healthy kidney to live.
• Cadaver donors. A cadaver donor is someone who has recently died. Most donor kidneys come from this source.

In both cases, the key to success is having the closest possible blood and tissue matches. A family member is not always the best match.

You will need to have tests to make sure the donor kidney matches your tissue type and blood type. This helps reduce the chances that your body will reject the new kidney. You will also be evaluated to make sure that you do not have significant heart or lung disease or other diseases, such as cancer, which might decrease your life span.

Kidney transplant surgery takes about 3 hours. During surgery, the donor kidney will be placed in your lower abdomen, blood vessels from the donor kidney will be connected to arteries and veins in your body, and the ureter from the donor kidney will be connected to your bladder. Blood is then able to flow through the new kidney, and the kidney will begin to filter and remove wastes and to produce urine.

The new kidney usually begins to function right away. In most cases, diseased or damaged kidneys are not removed unless you have a severe infection of the kidney (pyelonephritis), kidney cancer, nephrotic syndrome, or extremely large polycystic kidneys.

What To Expect After Surgery

You will have to stay in the hospital for 7 to 10 days after you receive your new kidney. In some cases, it may take time for your new kidney to produce urine, so you may have to receive dialysis and take medicines, such as diuretics, that help your new kidney get rid of excess water and salt from your body.

After the surgery you will have to take medicines, such as prednisone, azathioprine, and cyclosporine, to suppress your immune system. These medications are used to help keep your body from rejecting your new kidney. You will need to take these medicines for the rest of your life.

During the first weeks to months after your surgery, your body may try to reject your new kidney. This is called acute rejection and occurs in 25% to 55% of people after transplant. Most of the time, acute rejection can be treated with immunosuppressive medications.

Chronic rejection is a process of gradual, progressive loss of kidney function and can occur many months to several years after your surgery. Experts don't fully understand what causes chronic rejection. There is no treatment for chronic rejection; most people go back on dialysis or have another transplant.

Why It Is Done

During kidney transplant surgery, a healthy kidney (donor kidney) replaces the lost function of your own damaged kidneys. Kidney transplant is used when you have severe chronic kidney disease (renal failure) that cannot be reversed by another treatment method. You will not be able to have this surgery if you have an active infection, another life-threatening disease such as cancer, or severe heart or lung disease.

How Well It Works

If you have severe chronic kidney disease and choose to have a kidney transplant, you may live longer than if you choose only to treat your kidney disease with dialysis alone. Survival rates after a kidney transplant are:^{1, 2}

• 92% at 1 year.
• 80% at 5 years.
• 54% at 10 years.

Transplants using a kidney from a first-degree relative, such as your father, mother, brother, or sister, are the most successful. Success rates are better when people have a transplant before kidney failure becomes so severe that they need dialysis.^{2, 3}

Risks

The risks of having a kidney transplant include:

• Rejection of the new kidney.
• Severe infection.
• Bleeding.
• Reaction to the anesthesia used for surgery.
• Failure of the donor kidney.

What To Think About

Kidney transplant may be a better treatment for you than dialysis, because survival rates are better after transplant. You will also be able to live a more normal life, because you won't have to receive dialysis 3 times each week. Although a kidney transplant is an expensive procedure, it may actually be less costly than long-term dialysis treatments.

There is often a long wait before you receive a donor kidney, and there is no guarantee that the transplant will be successful. Fewer complications develop in people who are good candidates for surgery and who do not have other serious medical conditions, such as unstable coronary artery disease or cancer, that may limit their life expectancy.

Not everyone is able to have a kidney transplant. You will not usually have a kidney transplant if you have an active infection or another life-threatening disease, such as cancer or significant heart or lung disease.

After having a kidney transplant, you will have to take medicines that suppress your immune system (immunosuppressive medications), such as prednisone, azathioprine, and cyclosporine, to help prevent your body from rejecting the new kidney. You will need to take these medicines for the rest of your life. Because these medicines weaken your immune system, you will have an increased risk for developing serious infections. There is also the chance that your body may still reject your new kidney despite these medicines. If this happens, you will have to start dialysis and possibly wait for another kidney transplant.

Immunosuppressive medicines also increase your risk of other diseases, such as skin cancer, lymphoma, and Kaposi's sarcoma. You have a greater risk of developing diabetes, high blood pressure, heart disease, cataracts, and inflammation of the liver (cirrhosis) if you are taking these medicines.

Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.

Author:	Lila Havens	Last Updated November 17, 2005
Medical Review:	Martin Gabica, MD - Family Medicine D.C. Mendelssohn, MD, FRCPC - Nephrology
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