What Is a Kidney Transplant?
A kidney transplant is a surgical procedure that is appropriate for some people whose kidneys have failed. The kidneys filter waste from the blood and remove it from the body in the form of urine. They also help maintain the 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, which mechanically filters waste that builds up in the bloodstream when the kidneys cease to function. Some people whose kidneys have failed may qualify for a kidney transplant, in which one or both kidneys are replaced with donor organs.
There are pros and cons to both dialysis and kidney transplants. Undergoing dialysis is time-consuming and labor-intensive. A patient receiving dialysis must make frequent trips to a dialysis center to receive treatment, in which the blood is cleansed using a dialysis machine. If a patient decides to undergo dialysis in his or her own home, he or she must purchase and learn to use the necessary dialysis supplies.
If a patient is able to undergo a kidney transplant, he or she can be freed from lifelong dependence on dialysis machines and the strict schedule that goes with them. This can allow the patient to live a more active life. It is important to note, however, that kidney transplants are not suitable for everyone, including those with active infections and those who are severely overweight.
During a kidney transplant, a surgeon takes a donated kidney and places it in your body. Even though you are born with two kidneys, you can lead a healthy life with only one functioning kidney. After the transplant, you will have to take immune-suppressant medications to keep your immune system from attacking the new organ, and so to lower the risk of your body rejecting the new kidney.
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 he or she thinks you are a good candidate for a kidney transplant. In order to be a good candidate for a transplant, you will need to be healthy enough to undergo major surgery and to tolerate a strict, lifelong medication regimen after surgery. 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
If you have any of these underlying conditions, your doctor will probably recommend against a transplant. In addition, if you smoke, drink alcohol in excess, or abuse drugs, your doctor may also recommend against a transplant.
If your doctor thinks that you are a good candidate for a transplant, and you are interested in the procedure, you will 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 are 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 are released from the hospital.
If you are approved for a transplant, either a family member can donate a kidney, or you will be placed on a waiting list with the Organ Procurement and Transplantation Network (OPTN).
Who Donates the Kidney?
Kidney donors may be either alive or deceased.
Because the body can function perfectly well with just one kidney, a family member with two healthy kidneys may choose to donate one of them to you. If your blood and tissues are a good match, 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.
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 run a slightly higher risk of being 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 evaluation for a transplant, you will undergo blood tests to determine your blood type (A, B, AB, or O) and your human leukocyte antigen (HLA). HLA are a group of antigens located on the surface of your white blood cells. Antigens are responsible for your body’s immune response. Thus, if your HLA type matches the donor’s, it is 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, doctors will run 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. If your blood forms antibodies in response to the donor’s blood, the transplant can’t be done. If, on the other hand, your blood shows no antibody reaction, you are said to have a “negative cross match.” This means that the transplant can proceed.
How Is a Kidney Transplant Performed?
If your donor is alive, the doctor can schedule the transplant in advance. If, however, you’re waiting for a deceased donor who is a close match for your tissue type, you will have to be available to rush to the hospital at a moment’s notice when a donor is identified. Many transplant hospitals give their patients pagers or cell phones so that they can be reached quickly.
Once you arrive at the transplant center, the doctors will take a sample of your blood to run the antibody test. If the result is a “negative cross match,” you will be cleared for surgery.
A kidney transplant is done under general anesthesia. This involves giving you a medication that puts you to sleep during the surgery. While you are asleep, you won’t feel any pain. The anesthetic will be injected into your body through an intravenous (IV) line in your hand or arm.
Once you are asleep, the doctor makes an incision (cut) in your abdomen and places the donor kidney inside. The 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 (the tube that connects the kidney to the bladder) to your bladder so that you will be able to urinate normally.
If your malfunctioning kidneys are causing problems, such as infection or high blood pressure, the doctor will remove them during the transplant. If your old kidneys are not causing any complications, however, the doctor will leave them in your body.
You will wake up in a recovery room where hospital staff will monitor your vital signs until they are sure you are awake and stable. Then, they’ll transfer you to a hospital room. Even if you feel great after your transplant—and many people do—you will 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 are in the hospital, your doctors will monitor you for complications. They will also put you on a strict schedule of immunosuppressant drugs in an effort to stop your body from rejecting the new kidney. You will 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 about how and when to take your medications. Make sure that you understand these instructions and that you follow them exactly when you get home. Your doctors will also create a checkup schedule for you to follow after surgery.
Once you are discharged, you will need to keep regular appointments with your transplant team so that they can evaluate how well the new kidney is functioning in your body. You will need to take your immunosuppressant drugs as directed. You will also be prescribed additional drugs to reduce the risk of infection. Finally, you will need to monitor yourself for warning signs that your body has rejected the kidney, including pain, swelling, and flu-like symptoms.
You will need to follow up regularly with your doctor for the first one to two months after surgery. In total, 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 severe complications, including:
- an allergic reaction to general anesthesia
- blood clots
- leakage from the ureter
- blockage of the ureter
- rejection of the donated kidney
- failure of the donated kidney
- heart attack or stroke
In the worst-case scenario, your body rejects the new kidney. However, keep in mind that about 98 percent of living-donor kidney transplant recipients live for at least one year after surgery. About 90 percent live for at least five years after surgery. For those who received a deceased-donor kidney, 94 percent live for at least one year after surgery, and approximately 82 percent live for five years afterward (Mayo Clinic).
If you notice unusual soreness at the incision site or a change in the amount of urine that you are producing, let your transplant team know right away. If your body does reject the new kidney, you can resume dialysis and, after being re-evaluated, go back on the waiting list for another kidney.
The immunosuppressant drugs themselves can lead to some unpleasant side effects, such as weight gain, bone thinning, increased hair growth, acne, and a higher risk of developing certain skin cancers and non-Hodgkin’s lymphoma.