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by EBSCO Medical Review Board

Definition

A kidney transplant removes a damaged kidney and replaces it with a healthy one from a living donor or from someone who has died.

Normal Anatomy of the Kidney
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Reasons for Procedure

This surgery is done to treat kidney failure. This is when the kidneys are not removing waste and fluids from the body. It can be deadly. A transplant is done when other methods have not helped.

A transplant may also be done in people who had both kidneys removed.

Possible Complications

Problems are rare, but all procedures have some risk. The doctor will go over some problems that could happen, such as:

  • Excess bleeding
  • Problems from anesthesia, such as wheezing or sore throat
  • Infection
  • Blood clots
  • Blockages in the urinary tract
  • Urine leaking into the body
  • Damage to kidney blood vessels or nerves
  • Damage to nearby organs
  • Rejection of the new kidney
  • Heart attack
  • Death

Things that may raise the risk of problems are:

  • Smoking
  • Drinking excess alcohol
  • Chronic health problems, such as diabetes and obesity
  • Heart, lung, and liver diseases
  • HIV infection
  • Problems with the immune system
  • A current infection
  • Prior failed transplant

Lifelong medicine will be needed to suppress the immune system to lower the risk of the body rejecting the kidney. This can lead to problems, such as:

What to Expect

Prior to Procedure

A healthy family member can donate a kidney. If that is not an option, 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.

The surgical team may meet with you to talk about:

  • Anesthesia options
  • Any allergies you may have
  • Current medicines, herbs, and supplements that you take and whether you need to stop taking them before surgery
  • Fasting before surgery, such as avoiding food or drink after midnight the night before
  • Arranging a ride to and from surgery
  • Specialists you may need to see
  • Tests that will need to be done before surgery, such as tissue testing, cancer screening, and heart function tests

Anesthesia

General anesthesia will be used. You will be asleep.

Description of the Procedure

A cut will be made in the lower belly. The donated kidney will be connected to blood vessels. Blood flow can then pass to the new kidney. The tube (ureter) that carries urine to the bladder will also be attached.

The diseased kidney may be left in place or removed. It depends on if it is causing problems or if more room is needed. The cut will be closed with stitches or staples. A bandage will be placed over it. The new kidney may start making urine right away or within a short time.

Immediately After Procedure

Recovery will start in the intensive care unit (ICU). Staff will make sure the kidney is working well.

How Long Will It Take?

About 3 to 6 hours

Will It Hurt?

Anesthesia will prevent pain during surgery. Kidney function should improve in a few days. Pain and swelling are common in the first few weeks after surgery. Medicine and home care can help with healing.

Average Hospital Stay

The usual length of stay is 1 to 2 weeks. If you have any problems, you may need to stay longer.

Post-procedure Care

At the Hospital

After the procedure, the staff may:

  • Give you pain medicine
  • Start you on medicine to suppress the immune system to lower the risk of the body rejecting the new kidney
  • Test your kidney function
  • Have you wear special stockings to promote blood flow and lower the risk of blood clots

During your stay, the hospital staff will take steps to lower your risk of infection, such as:

  • Washing their hands
  • Wearing gloves or masks
  • Keeping your cuts covered

During your stay, you can also take steps to lower your risk of infection, such as:

  • Washing your hands often and reminding visitors and staff to do the same
  • Reminding staff to wear gloves or masks
  • Not letting others touch your cuts
At Home

It will take a few weeks for the cut to fully heal. Full recovery will take about two months. Physical activity will be limited during this time. You will need to ask for help with daily activities and delay your return to work.

Problems to Look Out For

Call the doctor if you are not getting better or you have:

  • Signs of infection, such as fever and chills
  • Redness, swelling, excessive bleeding, or discharge from the cut
  • Pain that you cannot control with medicine
  • Problems passing urine
  • Pain, burning, or blood in the urine
  • Nausea and vomiting
  • Black or tarry stools (poop), loose stools, or problems passing stool
  • Cough, shortness of breath, or chest pain
  • Coughing up blood
  • Severe headache
  • Lightheadedness or loss of consciousness
  • Pain or swelling in the feet, calves, or legs
  • Weight gain of more 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  https://www.niddk.nih.gov 

Urology Care Foundation  https://www.urologyhealth.org 

CANADIAN RESOURCES

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

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

References

Akbar SA, Jafri ZH, Amendola MA, et al. Complications of renal transplantation. RadioGraphics. 2005;25(5):1335-1356.

Chronic kidney disease (CKD) in adults. EBSCO DynaMed Plus website. Available at:  http://www.dynamed.com/topics/dmp~AN~T115336/Chronic-kidney-disease-CKD-in-adults  . Updated August 23, 2016. Accessed August 29, 2017.

Greco F, Fornara P, Mirone V. Renal transplantation: technical aspects, diagnosis and management of early and late urological complications. Panminerva Med. 2014 Mar;56(1):17-29.

Immunosuppression in kidney transplantation. EBSCO DynaMed Plus website. Available at:  http://www.dynamed.com/topics/dmp~AN~T912632/Immunosuppression-in-kidney-transplantation  . Updated July 24, 2017. Accessed August 29, 2017.

Kidney transplant. National Kidney Foundation website. Available at: https://www.kidney.org/atoz/content/kidneytransnewlease. Updated January 26, 2017. Accessed August 29, 2017.

Kidney (renal) transplantation.Urology Care Foundation website. Available at: http://www.urologyhealth.org/urologic-conditions/kidney-transplant. Updated January 2011. Accessed August 29, 2017.

11/30/2010 DynaMed Plus Systematic Literature Surveillance  http://www.dynamed.com/topics/dmp~AN~T115336/Chronic-kidney-disease-CKD-in-adults  : 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.dynamed.com/topics/dmp~AN~T905141/Treatment-for-tobacco-use  : Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.

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