Definition
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 KidneyCopyright © Nucleus Medical Media, Inc.
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Reasons for Procedure
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. A kidney transplant is only needed if both kidneys are not working. Common causes of kidney failure include:
- Uncontrolled high blood pressure
- Uncontrolled diabetes
- Autoimmune disorders, such as systemic lupus erythematosus
- Interstitial nephritis
- Glomerulonephritis
- Polycystic kidney disease
- Damage from a severe bacterial kidney infection
Possible Complications
Possible Complications
Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
- Infection
- Urinary/ureteral obstruction
- Bleeding
- Rejection of the new kidney
- Urine leakage into the body
- Blood clot
- Damage to blood vessels or nerves
- Damage to nearby organs
- 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
- Young age or increased age—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
What to Expect
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 medications
- Blood tests, including blood chemistries, liver function tests, bleeding profile, and infection testing
- Extensive tissue typing
- Electrocardiogram (EKG)
- Chest x-ray
- Psychological testing and counseling—to help you to be prepared for the transplant
Leading up to your procedure:
- Continue dialysis as instructed by your doctor.
- Talk to your doctor about your medications. You may be asked to stop taking some medications up to one week before the procedure.
- Take medications as directed. Do not take over-the-counter medications 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. you will be asleep during the procedure.
Description of the Procedure
An incision will be made in the lower abdomen. The donated kidney will be connected to your arteries, veins, and ureter, which is the tube that carries the urine to the bladder. In most cases, a diseased kidney will be left in place unless it is is causing problems or if room is needed for the transplant. The incision will be closed. The new kidney may start producing urine right away or within a short time.
Immediately After Procedure
You will be closely monitored in the intensive care unit (ICU) and will have the following devices:
- Breathing tube until you can breathe on your own
- IV fluids and medication
- Bladder catheter to drain urine
How Long Will It Take?
3-6 hours
How Much Will It Hurt?
Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.
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 immunosuppressive 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.
- Wear compression stockings to reduce the risk of blood clots.
At Home
When you return home, do the following to help ensure a smooth recovery:
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Take medication as advised by your doctor, which may include:
- Steroids to reduce inflammatoin and to prevent rejection
- Diuretics to stimulate kidney function and control blood pressure
- 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.
Call Your Doctor
Call Your Doctor
It is important for you to monitor your recovery after you leave the hospital. Alert your doctor to any problems right away. If any of the following occur, call your doctor:
- 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, 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, lightheadedness, or loss of consciousness
- Pain and/or swelling in your feet, calves, or legs
- Weight gain greater than 3 pounds in one day
If you think you have an emergency, call for medical help right away.
RESOURCES:
National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov
CANADIAN RESOURCES:
The Kidney Foundation of Canada http://www.kidney.ca
References:
Chronic kidney disease (CKD) in adults. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed
Updated August 11, 2014. Accessed August 13, 2014.
Halloran PF. Immunosuppressive drugs for kidney transplantation. N Engl J Med. 2004;351(26):2715-2729.
Kidney transplant. National Kidney Foundation website. Available at:https://www.kidney.org/atoz/content/kidneytransnewlease. Accessed August 13, 2014.
Kidney (renal) transplantation.Urology Care Foundation website. Available at:
http://www.urologyhealth.org/urologic-conditions/kidney-transplant
Updated January 2011. Accessed August 13, 2014.
11/30/2010 DynaMed’s Systematic Literature Surveillance
http://www.ebscohost.com/dynamed:
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
http://www.ebscohost.com/dynamed:
Mills E, Eyawo O, Lockhart I, et al. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.
Last Updated: 9/30/2013