by Carmack A

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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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:

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

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 directed 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. It will block any pain and keep you asleep through the surgery.

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 medicine
  • Bladder catheter to drain 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 medication.

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:
  • 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.
  • Ask your doctor about when it is safe to shower, bathe, or soak in water.

Call Your Doctor

After you leave the hospital, contact your doctor if any of these occur:
  • 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 three pounds in one day
If you think you have 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

CANADIAN RESOURCES

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

The Kidney Foundation of Canada http://www.kidney.ca

References

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

Chronic kidney disease. 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: 2715-2729.

Kidney transplant. National Kidney Foundation website. Available at: http://www.kidney.org/atoz/content/kidneytransnewlease.cfm. Accessed August 13, 2014.

Kidney (renal) transplantation. American Urological Association Foundation website. Available at: http://www.urologyhealth.org/urology/index.cfm?article=23&display=1. Updated January 2011. Accessed August 13, 2014.

11/30/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Stock PG, Barin 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, et al. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

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