Kidney Transplant
A kidney transplant is often the treatment of choice for kidney failure, compared with a lifetime on dialysis. A kidney transplant can treat chronic kidney disease or end-stage renal disease to help you feel better and live longer.
Compared with dialysis, kidney transplant is associated with:
- Better quality of life
- Lower risk of death
- Fewer dietary restrictions
- Lower treatment cost
Some people may also benefit from receiving a kidney transplant before needing to go on dialysis, a procedure known as preemptive kidney transplant.
But for certain people with kidney failure, a kidney transplant may be riskier than dialysis. Conditions that may prevent you from being eligible for a kidney transplant include:
- Advanced age
- Severe heart disease
- Active or recently treated cancer
- Dementia or poorly controlled mental illness
- Alcohol or drug abuse
- Any other factor that could affect the ability to safely undergo the procedure and take the medications needed after a transplant to prevent organ rejection
Only one donated kidney is needed to replace two failed kidneys, making living-donor kidney transplantation an option.
A kidney transplant is a surgery to place a healthy kidney from a living or deceased donor into a person whose kidneys no longer function properly.
The kidneys are two bean-shaped organs located on each side of the spine just below the rib cage. Each is about the size of a fist. Their main function is to filter and remove waste, minerals and fluid from the blood by producing urine.
When kidneys lose this filtering ability, harmful levels of fluid and waste accumulate in the body, which can raise blood pressure and result in kidney failure (end-stage renal disease). End-stage renal disease occurs when the kidneys have lost about 90% of their ability to function normally. End-stage renal disease occurs when the kidneys have lost about 90% of their ability to function normally.
Common causes of end-stage kidney disease include:
- Diabetes
- Chronic, uncontrolled high blood pressure
- Chronic glomerulonephritis — an inflammation and eventual scarring of the tiny filters within the kidneys
- Polycystic kidney disease
People with end-stage renal disease need to have waste removed from their bloodstream via a machine (dialysis) or a kidney transplant to stay alive.
At Mayo Clinic, health care professionals trained in many medical specialties work together as a team to ensure favorable outcomes from your kidney transplant.
Having all of this subspecialized expertise in a single place, focused on you, means that you’re not just getting one opinion — your care is discussed among the team, your test results are available quickly, appointments are scheduled in coordination, and your transplant care team works together to determine what’s best for you.
Types of Kidney Transplants
- Deceased-donor kidney transplant
- Living-donor kidney transplant
- Preemptive kidney transplant
Deceased-donor kidney transplant
A deceased-donor kidney transplant is when a kidney from someone who has recently died is removed with consent of the family or from a donor card and placed in a recipient whose kidneys have failed and no longer function properly and is in need of kidney transplantation.
The donated kidney is either stored on ice or connected to a machine that provides oxygen and nutrients until the kidney is transplanted into the recipient. The donor and recipient are often in the same geographic region as the transplant center to minimize the time the kidney is outside a human body.
Only one donated kidney is needed to sustain the body’s needs. For this reason, a living person can donate a kidney, and living-donor kidney transplant is an alternative to deceased-donor kidney transplant.
Overall, about two-thirds of the approximately 20,000 kidney transplants performed each year in the U.S. are deceased-donor kidney transplants, and the remaining are living-donor kidney transplants.
The demand for deceased-donor kidneys far exceeds the supply. The waiting list has grown from nearly 58,000 in 2004 to more than 92,000 in 2017.
Living-donor kidney transplant
A living-donor kidney transplant is when a kidney from a living donor is removed and placed into a recipient whose kidneys no longer function properly.
Only one donated kidney is needed to replace two failed kidneys, which makes living-donor kidney transplant an alternative to deceased-donor kidney transplant.
About one-third of all kidney transplants performed in the U.S. are living-donor kidney transplants. The other two-thirds involve a kidney from a deceased donor.
Why it’s done
Compared with deceased-donor kidney transplant, the benefits of living-donor kidney transplant include:
- Less time spent on a waiting list, which could prevent possible complications and deterioration of health of the recipient
- Potential avoidance of dialysis if it has not been initiated
- Better short- and long-term survival rates
- Your transplant may be scheduled in advance once your donor is approved versus an unscheduled, emergency transplant procedure with a deceased donor kidney
The risks of living-donor kidney transplant are similar to those of deceased-donor kidney transplant. They include risks associated with the surgery, organ rejection and side effects of anti-rejection medications.
What you can expect
Living-donor kidney transplant usually involves a donated kidney from someone you know, such as a family member, friend or co-worker. Genetically related family members are most likely to be compatible living kidney donors.
A living kidney donor may also be someone you don’t know, a non-directed living kidney donor.
Both you and your living kidney donor will be evaluated to determine if the donor’s organ is a good match for you. In general, your blood and tissue types need to be compatible with the donor.
However, even if your donor isn’t a match, in some cases a successful transplant may still be possible with additional medical treatment before and after transplant to desensitize your immune system and reduce the risk of rejection.
If your living kidney donor isn’t compatible with you, your transplant center may offer you and your donor the chance to participate in the paired donation program. In paired living-organ donation, your donor gives a kidney to someone else who is compatible. Then you receive a compatible kidney from that recipient’s donor.
Once you’ve been matched with a living kidney donor, the kidney transplant procedure will be scheduled in advance. The kidney donation surgery (donor nephrectomy), and your transplant typically occur on the same day.
Preemptive kidney transplant
A preemptive kidney transplant is when you receive a kidney transplant before your kidney function deteriorates to the point of needing dialysis to replace the normal filtering function of the kidneys.
Currently, most kidney transplants are performed on people who are on dialysis because their kidneys are no longer able to adequately clean impurities from the blood.
Preemptive kidney transplant is considered the preferred treatment for end-stage kidney disease, but only about 20% of kidney transplants are performed preemptively in the U.S.
Several factors have been linked to the lower than expected rate of preemptive kidney transplants, such as:
- Shortage of donor kidneys
- Lack of access to transplant centers
- Low rates of physician referrals for the procedure among candidates of lower socioeconomic status
- Lack of physician awareness of current guidelines
Why it’s done
The benefits of preemptive kidney transplant before dialysis for people with end-stage kidney disease include:
- Lower risk of rejection of the donor kidney
- Improved survival rates
- Improved quality of life
- Lower treatment costs
- Avoidance of dialysis and its related dietary restrictions and health complications
These benefits of preemptive kidney transplant are especially significant among children and adolescents with end-stage kidney disease.
Risks of preemptive kidney transplant include early exposure to the risks associated with surgery and potentially wasting native kidney function.
What you can expect
If your doctor recommends a preemptive kidney transplant, you will be referred to a transplant center for evaluation. You’re also free to select a transplant center on your own or choose a center from your insurance company’s list of preferred providers.
At the transplant center, your transplant team will conduct several tests to determine if a preemptive kidney transplant is appropriate for you. Your team will consider a variety of factors, including:
- Level of kidney function
- Overall health
- Any chronic medical conditions that might affect the success of transplant
- Availability of donor kidney
- Ability to follow medical instructions and take anti-rejection medications for the rest of your life
If you are approved for a preemptive kidney transplant and a living-donor kidney is available, the living-donor kidney transplant procedure will be scheduled. If a living-donor kidney is not available, you will be placed on a waiting list for a deceased-donor kidney transplant.
Preparation for Kidney Transplant
Before the procedure
Finding a match
A kidney donor can be living or deceased, related or unrelated to you. Your transplant team will consider several factors when evaluating whether a donor kidney will be a good match for you.
Tests to determine whether a donated kidney may be suitable for you include:
Blood typing. It’s preferable to get a kidney from a donor whose blood type matches or is compatible with your own.
Transplants involving a donor and recipient with incompatible blood types are also possible but require additional medical treatment before and after transplant to reduce the risk of organ rejection. These are known as ABO incompatible kidney transplants.
- Tissue typing. If your blood type is compatible, the next step is a tissue typing test called human leukocyte antigen (HLA) typing. This test compares genetic markers that increase the likelihood the transplanted kidney will last a long time. A good match means it’s less likely that your body will reject the organ.
Crossmatch. The third and final matching test involves mixing a small sample of your blood with the donor’s blood in the lab. The test determines whether antibodies in your blood will react against specific antigens in the donor’s blood.
A negative crossmatch means they are compatible and your body isn’t as likely to reject the donor kidney. Positive crossmatch kidney transplants also are possible but require additional medical treatment before and after the transplant to reduce the risk of your antibodies reacting to the donor organ.
Additional factors your transplant team may consider in finding the most appropriate donor kidney for you include matching age, kidney size and infection exposure.
Living kidney donation
Finding a willing living kidney donor is an alternative to waiting for a compatible deceased-donor kidney to become available.
Family members are often the most likely to be compatible living kidney donors. But successful living-donor transplants are also common with kidneys donated from unrelated people, such as friends, co-workers or religious congregation members.
Paired donation is another type of living kidney donation if you have a willing kidney donor whose organ isn’t compatible with you or doesn’t match well for other reasons. Rather than donating a kidney directly to you, your donor may give a kidney to someone who may be a better match. Then you receive a compatible kidney from that recipient’s donor.
In some cases, more than two pairs of donors and recipients may be linked with a living kidney donor who hasn’t named a specific person to receive the kidney. They form a donation chain with several recipients benefiting from the nondirected donor’s gift.
If a compatible living donor isn’t available, your name will be placed on a waiting list for a deceased-donor kidney. Because there are fewer available kidneys than there are people waiting for a transplant, the waiting list continues to grow. The waiting time for a deceased-donor kidney is usually a few years.
Kidney Transplant Procedure
During the procedure
Kidney transplants are performed with general anesthesia, so you’re not awake during the procedure. The surgical team monitors your heart rate, blood pressure and blood oxygen level throughout the procedure.
During the surgery:
- The surgeon makes an incision in the lower part of one side of the abdomen and places the new kidney into the body. Unless your own kidneys are causing complications such as high blood pressure, kidney stones, pain or infection, they are left in place.
- The blood vessels of the new kidney are attached to blood vessels in the lower part of the abdomen, just above one of your legs.
- The new kidney’s ureter — the tube that links the kidney to the bladder — is connected to the bladder.
After the procedure
After a kidney transplant, you can expect to:
Spend several days to a week in the hospital. Doctors and nurses monitor your condition in the hospital’s transplant recovery area to watch for signs of complications.
Your new kidney will make urine like your own kidneys did when they were healthy. Often this starts immediately. In other people, it may take several days, and you may need temporary dialysis until your new kidneys begin to function properly.
Expect soreness or pain around the incision site while you’re healing. Most kidney transplant recipients can return to work and other normal activities within eight weeks after transplant. Avoid lifting objects weighing more than 10 pounds or exercising other than walking until the wound has healed (usually about six weeks after surgery).
Have frequent checkups as you continue recovering. After you leave the hospital, close monitoring is necessary for a few weeks to check how well your new kidney is working and to make sure your body is not rejecting it.
You may need to have blood tests several times a week and have your medications adjusted in the weeks following your transplant. During this time, if you live in another town, you may need to make arrangements to stay near the transplant center.
- Take medications the rest of your life. You’ll take a number of medications after your kidney transplant. Immunosuppressant drugs help keep your immune system from attacking and rejecting your new kidney. Additional drugs help reduce the risk of other complications, such as infection, after your transplant.
Benefits of Kidney Transplant
A kidney transplant is often the treatment of choice for kidney failure, compared with a lifetime on dialysis. A kidney transplant can treat chronic kidney disease or end-stage renal disease to help you feel better and live longer.
Compared with dialysis, kidney transplant is associated with:
- Better quality of life
- Lower risk of death
- Fewer dietary restrictions
- Lower treatment cost
Some people may also benefit from receiving a kidney transplant before needing to go on dialysis, a procedure known as preemptive kidney transplant.
But for certain people with kidney failure, a kidney transplant may be riskier than dialysis. Conditions that may prevent you from being eligible for a kidney transplant include:
- Advanced age
- Severe heart disease
- Active or recently treated cancer
- Dementia or poorly controlled mental illness
- Alcohol or drug abuse
- Any other factor that could affect the ability to safely undergo the procedure and take the medications needed after a transplant to prevent organ rejection
Only one donated kidney is needed to replace two failed kidneys, making living-donor kidney transplantation an option.
After a successful kidney transplant, your new kidney will filter your blood, and you will no longer need dialysis.
To prevent your body from rejecting your donor kidney, you’ll need medications to suppress your immune system. Because these anti-rejection medications make your body more vulnerable to infection, your doctor may also prescribe antibacterial, antiviral and antifungal medications.
It is important to take all your medicines as your doctor prescribes. Your body may reject your new kidney if you skip your medications even for a short period of time. Contact your transplant team immediately if you are having side effects that prevent you from taking the medications.
After the transplant, be sure to perform skin self-checks and get checkups with a dermatologist to screen for skin cancer. Also, staying up to date with other cancer screening is strongly advised.
If your new kidney fails, you can resume dialysis or consider a second transplant. You may also choose to discontinue treatment. If you decide to discontinue treatment, your doctor can give you medicines to help relieve your symptoms. This decision depends on your current health, your ability to withstand surgery and your expectations for maintaining a certain quality of life.
