Renal transplant
A renal transplant, also known as a kidney transplant, is a surgical procedure to place a healthy kidney from a donor into a person whose kidneys no longer work properly. This treatment offers improved survival and quality of life compared to dialysis for people with kidney failure.
Table of contents
- What is a kidney transplant?
- When a kidney transplant is needed
- Types of kidney transplants
- Requirements and evaluation
- The transplant waiting list
- The transplant surgery
- Recovery after transplant
- Life-long medications
- Risks and complications
- Staying healthy after transplant
What is a kidney transplant?
A kidney transplant is a surgery where a healthy kidney from a donor is placed into the body of someone whose kidneys no longer function properly.[1] The kidneys are two bean-shaped organs located on each side of the spine, just below the rib cage. Their main job is to filter and remove waste, minerals, and fluid from the blood by producing urine.[1]
During the transplant surgery, the donated kidney is placed in the lower abdomen, typically on the lower right or left side.[5] The blood vessels of the new kidney are attached to blood vessels in the lower part of the abdomen, and the new kidney’s ureter (the tube that carries urine) is connected to the bladder.[1] In most cases, your original kidneys are left in place unless they are causing complications.[1]
Kidney transplantation is often the preferred treatment for those with end-stage renal disease (a condition where kidneys have lost about 90% of their ability to work properly).[3] Patients who undergo kidney transplantation have better long-term survival and often experience a better quality of life compared to those who remain on dialysis.[3]
When a kidney transplant is needed
Kidney transplants are done to help people with chronic kidney disease or end-stage kidney failure.[5] When kidneys lose their filtering ability, harmful levels of fluid and waste collect in the body, which can raise blood pressure and result in kidney failure.[1]
Common causes of end-stage renal disease include diabetes, ongoing uncontrolled high blood pressure, inflammation and scarring of the tiny filters within the kidneys (glomerulonephritis), lupus nephritis, and polycystic kidney disease.[1]
People with end-stage renal disease need to have a kidney transplant or dialysis (a process that removes waste from the bloodstream using a machine) to stay alive.[1] A working transplanted kidney does a better job of filtering wastes and keeping you healthy than dialysis.[7]
Types of kidney transplants
Kidneys for transplantation can come from living donors or deceased organ donors.[5]
Living donor transplant
A living donor means your kidney comes from someone who is still alive with healthy kidneys.[5] Common living donors are immediate family members, spouses, partners, or friends, but living donors can be almost anyone.[5] A living donor must be older than 18, healthy with no major medical issues, and pass a medical and psychosocial evaluation.[5]
Living donor kidney transplants are more successful, with more advantages and with a lower rate of rejection.[5] However, living donors are harder to find, which makes them more rare.[5]
Deceased donor transplant
A deceased donor kidney comes from someone who has just died of causes that don’t affect the function of their kidney.[5] People who want to be organ donors elect to do so while they’re still alive. Permission for donation can also be given by the deceased person’s family after their death.[5] Deceased donor transplants occur more frequently.[5]
Potential kidney donors are carefully screened to make sure they’re a match. This helps prevent complications.[5]
Requirements and evaluation
Each hospital has its own criteria for accepting people as kidney transplant recipients.[5] In general, candidates for kidney transplant should have end-stage renal failure and be on dialysis, or chronic kidney disease with a glomerular filtration rate (a measurement of kidney function) less than or equal to 20 mL/min.[5] Candidates should have a full understanding of postoperative instructions and care, and be in good overall physical and mental health with strong social support.[5]
The first step is to talk with your doctor to find out whether you’re a candidate for a transplant.[7] If you want a kidney transplant, your doctor will refer you to a transplant center for tests to see if you’re healthy enough to receive a transplant.[7]
There are some general factors that could make a person ineligible for a kidney transplant, such as a serious health condition, certain infections, cancer or history of cancer, certain mental health conditions, poor social support, a short life expectancy, or history of non-compliance with medical treatment.[5]
While there really is no age limit, most facilities accept people who are 17 and older.[5] Kidney transplant evaluation has more to do with meeting the criteria than age.[5]
The transplant waiting list
If you don’t have a living donor, you’ll be placed on a waiting list to receive a kidney from a deceased donor.[7] To get on the list for a deceased donor kidney, your name must be added to the national waiting list for organs from deceased donors, which is managed by the United Network for Organ Sharing (UNOS).[6]
Due to the shortage of kidneys, patients on the waiting list for a deceased donor kidney may wait many years.[3] You’ll have monthly blood tests while you wait for a kidney.[7] You must go to the hospital to have your transplant as soon as you learn a kidney is available.[7] If you have a living donor, you can schedule the transplant in advance.[7]
The transplant surgery
During kidney transplant surgery, the donor kidney is placed in your lower abdomen.[1] Blood vessels of the new kidney are attached to blood vessels in the lower part of your abdomen, just above one of your legs.[1] The new kidney’s ureter is connected to your bladder.[1] Unless they are causing complications, your own kidneys are left in place.[1]
Open and laparoscopic surgery are the two approaches for both procurement and transplantation.[3] For a straightforward transplant, a hospital stay might be seven to ten days, but if there are complications, the hospital stay might be up to a few weeks.[23]
Your new kidney may start working very soon after surgery, or it may take a few weeks.[21] If your kidney doesn’t start to work right away, you’ll need to have dialysis until the new kidney can take over.[21] Many newly transplanted kidneys go through a phase of “delayed graft function,” which could last a few days or even many weeks.[23]
Recovery after transplant
Your belly and side will be sore for the first 1 to 2 weeks after surgery.[21] You also may have some numbness around the incision the doctor made.[21] You may feel tired while you are healing. It may take 3 to 6 weeks for your energy to fully return.[21]
Most people are able to return to work about 4 weeks after surgery, depending on the type of work you do and how you feel.[21] For 4 to 6 weeks, avoid lifting anything that would make you strain and avoid exercises that strain your belly muscles.[21]
Try to walk each day, gradually increasing the amount you walk.[21] Walking boosts blood flow and helps prevent pneumonia and constipation.[21] Rest when you feel tired, as getting enough sleep will help you recover.[21]
Life-long medications
After the transplant, you must take medicine to keep your body from rejecting the new kidney.[21] You will need to take anti-rejection medicine every day from now on.[21] Taking your medications exactly as prescribed is one of the most important steps in protecting your new kidney.[22]
Immunosuppressants are medications that help your body accept the transplanted organ by decreasing the activity of your immune system.[13] Missing doses or altering your medication schedule, even occasionally, can increase the risk of rejection.[22]
Common immunosuppressants include tacrolimus (Prograf), cyclosporine, sirolimus (Rapamune), mycophenolate (CellCept), and prednisone.[11] Each of these medications has potential side effects, but not all patients suffer from all the side effects listed.[11]
These medicines have side effects. One side effect is that your body may be less able to fight infections.[21] All immunosuppressant drugs work to prevent your immune system from rejecting your transplanted organ, which also means they make it harder for your immune system to fight bacteria, viruses, and cancer cells.[11]
In addition to the immunosuppressants, you may also need to take other medicines to treat high blood pressure, diabetes, or other conditions, and antibiotics for the first three to six months after your transplant to help prevent infection.[11] It is not uncommon for patients to go home on ten to twelve different medicines after their transplant.[11]
Risks and complications
Despite significant advancements in immunosuppressive therapies, kidney transplant rejection continues to pose a substantial challenge, impacting the long-term survival of grafts.[16] The main types of rejection are T-cell-mediated rejection (TCMR) and antibody-mediated rejection (ABMR).[16]
TCMR is diagnosed through examination of kidney biopsy samples, which reveal the infiltration of certain immune cells into the transplant tissue.[16] Corticosteroids serve as the primary treatment for TCMR, while severe or steroid-resistant cases may require stronger agents.[16]
ABMR occurs due to the binding of antibodies to the blood vessel cells of the transplant.[16] Treatment approaches include plasmapheresis, intravenous immunoglobulins, and other therapies, though their efficacy remains variable.[16]
Patients with kidney transplants have a significant number of pre-existing conditions and use of immunosuppression medications, which puts them at higher risk of developing conditions such as hypertension, high cholesterol levels, diabetes after transplant, cardiovascular events, and anemia.[13] They are particularly susceptible to infections such as urinary tract infections, and cancers, especially skin cancer.[11]
Despite maximizing treatment of rejection episodes, some cases may not be reversed and may impact transplant survival.[16] Even if maximum treatment is administered, certain kidney transplants may not recover function.[16]
Staying healthy after transplant
Adopting a healthy lifestyle is crucial to protecting your transplant and enjoying long-term wellness.[22] A balanced diet, regular exercise, and maintaining a healthy weight are all important factors that contribute to the overall success of your transplant.[25]
Nutrition and diet
A healthy diet after a kidney transplant supports both your new kidney and your overall well-being.[22] Focus on eating plenty of fresh fruits, vegetables, whole grains, and lean proteins.[22] Limiting salt helps control blood pressure, which is especially important for kidney health.[22] Cutting back on processed foods, fried foods, and sugary snacks can also lower your risk of diabetes and heart disease.[22]
Follow your doctor’s instructions about what to eat after your surgery.[21] Drink plenty of fluids unless your doctor tells you not to.[21] Check with your doctor before you drink alcohol, as alcohol can cause problems with some of the medicines used to prevent organ rejection.[21]
Physical activity
Exercise is one of the best ways to strengthen your body and protect your new kidney.[22] Regular physical activity can help maintain a healthy weight, improve heart health, and boost energy levels, all of which contribute to long-term transplant success.[22]
In general, athletic activities are safe and encouraged for transplant recipients.[19] Safer activities include running, basketball, swimming, volleyball, cycling, and tennis.[19] Less safe activities have a higher chance of physical injury, such as football, karate, ice hockey, and power lifting.[19] Ask your transplant team when it’s safe to restart your pre-transplant activities.[19]
Preventing infections
It’s important to take steps to avoid infections.[21] Stay away from crowds of people and anyone who might have an infection or an illness such as a cold or influenza.[21] You will need to have regular physicals with your primary care doctor for cancer screening, including screening for skin cancer, which is the most common post-transplant cancer.[11]
For activities outside with a lot of sun exposure, it is important to protect your skin. Wear sunscreen of SPF 30 or higher, avoid the sun during peak hours from 10am to 4pm, and avoid tanning beds.[19]
Having pets is wonderful for mental health, but transplant recipients must be careful with pets because they have a higher chance of getting infections from animals.[19] Dogs and cats are generally safe, but they must be up-to-date with their healthcare.[19] Avoid certain pets such as rodents, reptiles, amphibians, and birds due to the higher chance of infection.[19]
Regular follow-up care
Regular communication with your healthcare team is vital to ensure your kidney is functioning well.[22] This includes attending all scheduled appointments with your transplant team, primary care physician, nephrologist, and other specialists as needed.[22] Frequent lab work is also necessary to monitor your kidney function and detect any early signs of potential issues.[22]
In some cases, people can have two, three, or more kidney transplants in their lifetimes.[5] Every person is different, and your healthcare provider can tell you if this is an option for you.[5]
Having an organ transplant can bring up many emotions. You may feel grateful and happy, but you also may feel guilty or depressed.[21] Seek out family, friends, and counselors for support.[21] If you think you are depressed, ask your doctor for help, as treatment can help you feel better.[21]
