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Understanding Transplantation
Whether you are a transplant recipient or someone wanting to learn more about transplantation, you can find answers to many of your questions by taking a look at the following Frequently Asked Questions (FAQs). The FAQs found here cover general transplantation topics. To gain information made for your specific needs Pre-transplant, during the first year, and beyond year
one, visit the area of this site that’s right for you.
We encourage you to speak with your doctor for more information.
What is transplantation?
Transplantation is the surgical removal of a healthy organ from one person for placement into another person to replace a sick or injured organ.
Organs that can be transplanted include:
- Liver
- Kidney
- Pancreas
- Heart
- Lung
- Intestine
Why is transplantation necessary?
Transplantation is necessary when illness or injury leads to organ failure.
What is the United Network for Organ Sharing ( UNOS)? UNOS guarantees that all people who need a transplant have an equal opportunity to receive their organs, regardless of age, sex, race, social status, etc. Who gets an available organ is determined by a number of factors, including the length of time a recipient has been on the waiting list, blood type (ABO typing), body size, and health status as determined by UNOS criteria. If you would like to learn more, contact UNOS at 1-888-894-6361.
What is the difference between living-donor and deceased-donor organ donation?
Living-donor organ donation means that a person who is still living chooses to donate a kidney or a portion of their liver to someone in need, such as a relative, friend, or stranger.
Deceased-donor organ donation is donation of an organ or organs after a person dies.
Living-donor criteria
Liver donation: There are many criteria that must be considered for a person to donate a portion of his or her liver, including age, medical history, and current health status. The potential donor will undergo blood tests, a physical and psychological exam, x-ray tests to evaluate liver size, and possible liver biopsy.
Kidney donation: Transplants using a kidney from a living donor is increasing. A living donor may be a relative, spouse, friend, or even a stranger. The benefits of using a living donor include a reduction or elimination of the waiting time, possible avoidance of dialysis, the ability to schedule the surgery, and a kidney that usually starts working faster.
A potential living donor for kidney transplant must undergo a thorough medical evaluation similar to the one the recipient goes through. The physician will select a donor who matches the recipient in regard to ABO blood type and human leukocyte antigen (HLA) compatibility. After the surgery, the donor must receive annual physician follow-up visits and should closely monitor his or her blood pressure.
If a living-donor transplant is not possible, the recipient will be placed on the waiting list for a deceased-donor organ.
How is waiting list status determined?
The status of a person awaiting a transplant organ is determined by such factors as severity of disease and time on the waiting list. When a donor organ becomes available, the people for whom that organ is a perfect match are identified, and the organ is offered to the patient who has the most urgent need for the organ, based on his or her current health status. Therefore, the sickest people receive organs before those whose health status will allow them to wait longer for their transplants.
What diseases or conditions commonly lead to liver transplantation?
The most common causes of liver disease that lead to liver transplantation are cirrhosis and hepatitis—both of which occur in a variety of forms and are chronic conditions. For additional information, please refer to the American Liver Foundation.
Cirrhosis
Cirrhosis is an ongoing liver disease that may occur over a period of months to years. Cirrhosis destroys liver cells, which causes the liver to eventually shrink and harden. Ultimately, the liver will lose too many cells and lack proper blood flow. This process results in liver failure. There are different causes of cirrhosis.
Primary biliary cirrhosis destroys the bile ducts in the liver. When bile ducts are destroyed, the liver can no longer secrete bile. Bile is required for the breakdown and digestion of fats. Alcoholic cirrhosis is the widespread death of liver cells caused by long-term alcohol drinking.
Hepatitis
Hepatitis is an inflammation of the liver often caused by hepatitis A, B, or C, or other viruses such as the Epstein-Barr virus (EBV) or cytomegalovirus (CMV). Inflammation of the liver can also be caused by alcohol abuse and drug use.
Hepatitis C, which is usually transmitted through blood, is the most common reason people need liver transplants. Other, less common causes of liver disease are:
Alagille syndrome
Alpha1-antitrypsin deficiency
Autoimmune hepatitis
Budd-Chiari syndrome
Cancer of the liver
Fulminant liver failure
Hemochromatosis
Primary sclerosing cholangitis
Wilson's disease
Symptoms of liver disease
The most common clinical symptoms associated with chronic liver disease are listed below. People with liver disease may experience one or more of these symptoms:
- Nausea and vomiting
- Loss of appetite
- Weight loss
- Fatigue
- Yellow discoloration of the skin and the whites of the eyes (jaundice)
- Extreme itching sensation
- Dark urine
- Vomiting of blood
- Dark gray- or clay-colored stools
- Buildup of fluid in the abdomen
- Shortness of breath
- Lack of blood clotting, which may lead to nose bleeds, bruises, bleeding, etc.
- Mental confusion
There are several other less common signs and symptoms of liver disease, some of which are only noticed after medical testing. These symptoms include damage of veins in the stomach and esophagus and the belching of stomach contents back into the esophagus. Kidney failure can sometimes occur as a result of liver complications (hepatorenal syndrome).
Abnormal levels of potassium, sodium, albumin, or glucose can also be signs of liver disease. These signs may only be detectable through medical testing.
If you are experiencing any of these effects, you should see your doctor immediately.
Effects of liver disease
Liver failure results in a decrease in the development of proteins that are necessary to keep fluid in the bloodstream. Liver disease can also cause serious internal problems, including increased risk of liver cancer, kidney failure, and internal bleeding.
In addition to the physical problems, people with liver disease often suffer from some mental difficulties. These problems can range from weak hand/eye coordination to memory loss and confusion. These effects on mental status result from the buildup of nitrogen waste products (ammonia) in the bloodstream.
How is liver transplantation done?
Deceased-donor Liver Transplantation
The majority of organs used for liver transplants today come from people whose livers is donated at the time of their deaths. There is much preparation once the liver recipient gets to the hospital:
- The patient is prepared for the operation in the operating room or holding area
- At this time, the patient will receive anesthetic to make him or her sleep
- Once the patient is asleep and all of the preparation is done, the surgeon will begin the operation to remove the diseased liver
During the removal of the patient's liver, one of the other surgeons will check and prepare the new liver for the transplant. Once prepared, the new liver will be put in place:
- The blood vessels will be sewn together, and the bile duct of the donor liver will be sewn to the bile duct of the recipient
- The abdomen will be closed using special stitches, some of which will dissolve over time
- The patient is taken directly to the intensive care unit, where the staff will monitor the patient’s vital signs very closely, it may be at least an hour before family members will be able to see the patient after surgery
Living-Donor Liver Transplantation
A healthy liver has the ability to regenerate. This means a healthy liver can grow back to its normal size in the donor and the recipient. This is exciting for liver recipients waiting for transplants. They can now receive a piece of a healthy liver from a living donor.
There are many criteria that must be considered for a person to donate a portion of his or her liver, including age, medical history, and current health status. The potential donor will undergo blood tests, a physical and a psychological exam, x-ray tests to evaluate liver size, and possible liver biopsy.
Before the operation, the surgeons will determine the amount of liver needed for the recipient to receive and the donor to keep. The donor will be in the hospital for approximately one week following surgery, with a continued four to six weeks of rest at home. It is important for the donor to follow up with the surgeon and a hepatologist for the first year post-surgery to make sure the liver is operating and growing normally.
The surgery and post-surgical care for the living donor recipient is the same as described above for a recipient who receives a deceased-donor liver. The surgeon may have to sew the blood vessels slightly differently, depending on which part of the liver is used. The bile ducts will be connected in a similar fashion. The operation takes approximately the same as the deceased-donor liver, six to 12 hours.
What diseases or conditions commonly lead to kidney transplantation?
Adults
The most common causes of kidney failure in adults are long-term complications of diabetes (high blood sugar) and hypertension (high blood pressure). Other diagnoses that lead to kidney disease in adults include: systemic lupus erythematosus, polycystic kidney disease, and glomerulonephritis.
Children
Causes of kidney disease in children and adults are generally very different. Children often have a higher rate of inherited (congenital) or metabolic disease present at birth and abnormally developed urinary systems.
Symptoms of kidney disease
Kidneys are bean shaped and located near the middle of the back. Their function is to filter and eliminate waste products from the body and make chemicals (hormones) that keep the bones strong and the blood healthy. When the kidneys cannot remove waste, you can have symptoms that include the following:
- Swelling of different body parts, mainly around the ankles, hands, and eyes
- Blood in the urine
- High blood pressure
If you are having any of these symptoms, you should call your doctor. Your doctor will run lab tests to see if you are in the early stages of kidney disease.
What is dialysis?
When your kidneys can no longer perform the function of removing waste products from your body and a transplant is not an immediate option, dialysis may be necessary. Dialysis is one of the most common treatments for people with kidney disease. There are two kinds of dialysis: hemodialysis and peritoneal dialysis. Unfortunately, dialysis does have some unpleasant side effects, and it requires lifestyle changes. And, as it removes waste products, it can also remove important vitamins and minerals, leaving you exhausted. In addition, you must carefully watch your diet.
Hemodialysis filters harmful waste from the blood. The blood is removed from your body through a catheter, usually inserted in your arm, and is run through a machine. The blood is then returned to your body through another catheter. It usually takes three hours a day, three times a week at a dialysis center. People must maintain a very strict diet while on hemodialysis. Fluid intake must be limited, because the kidneys cannot remove the extra fluid fast enough. Some side effects of hemodialysis include a quick change in body fluids, muscle cramps, low blood pressure (hypotension), and nausea.
Peritoneal dialysis removes excess water, waste, and chemicals from the body. It uses a fluid (dialysate) that is put into your belly through a catheter to remove the waste in your blood. After a few hours, the fluid is drained and a fresh bag of dialysate is put in. Treatments can be given at home or at a dialysis center. A typical schedule requires four exchanges a day, each with a “dwell time” (amount of time the solutions stays in your belly) of four to six hours. Continuous ambulatory peritoneal dialysis (CAPD) doesn't require a machine and is the most common form of peritoneal dialysis. Other types of peritoneal dialysis use a machine called a cycler to fill and drain your abdomen, usually overnight. The most common problem with peritoneal dialysis is infection around the catheter site.
How is living kidney donation done?
Laparoscopic Surgery
In recent years, donor surgery has undergone a change. The donor's kidney can now be removed laparoscopically. This approach requires three to four small cuts for placement of the surgical instruments and removal of the kidney. The donor is usually in the operating room for only about two to three hours. For the donor, the laparoscopic approach has several advantages: post-operative pain and the length of the hospital stay are decreased. There are also very few complications for the donor with the laparoscopic procedure. However, occasionally there will be some bleeding that is usually corrected immediately. Like all surgery, donating a kidney involves risk. Make sure you understand these risks before undergoing this procedure.
Conventional Surgery
The traditional operation to remove a kidney from a living donor involves a cut into the back and sometimes the removal of a rib. This procedure is difficult for the donor and requires more recovery time, usually about five to seven days in the hospital and eight to 12 weeks away from work, and usually involves more pain. However, there are minimal serious complications for the donor when it is performed by an experienced transplant team. Like all surgery, donating a kidney involves risk. Make sure you understand these risks before undergoing this procedure.
What is kidney transplantation surgery like for the recipient?
Regardless of whether the kidney is from a living or deceased donor, the transplant operation for the recipient involves general anesthesia and treatment with anti-rejection drugs before the transplant.
- A small cut (approximately four to five inches long) is typically made in the lower left side of the abdomen, and the kidney is placed into the space
- The blood vessels of the donor kidney are sewn to the recipient's blood vessels
- Then the surgeon connects the ureter to the bladder and closes the cut
- The recipient operation usually takes one to two hours
- The recipient will usually be in the hospital for about one week and can return to his or her normal lifestyle in about three months
What can I expect to experience during post-transplant recovery?
Following Liver Transplantation
The period immediately following liver transplant is a very critical time for you. Your doctors and nurses will monitor you very closely. As your condition begins to stabilize, you and your family will be taught about medications, diet, and other important issues. Most people can go home seven to 12 days following their transplant and can return to work and their normal, active lives within three months.
Following Kidney Transplantation
After your transplant, your new kidney should work very well. In fact, approximately 80% of deceased-donor kidney recipients and 95% of living donor kidney recipients have kidneys that work immediately. In some cases, it takes a couple of weeks before the kidney starts working. This is called delayed graft function.
After the transplant, the patient is monitored in the recovery room for several hours and then moved to a step-down or transplant unit. The average hospital stay is four to seven days, depending on the function of the kidney. Most transplant recipients will return to normal activities and lifestyle within several weeks to months after receiving their kidney transplants.
What are the potential complications of transplantation?
It is important to remember that transplantation is a serious surgery and risks still remain. Talk to your transplant team about what you can expect and make sure your concerns are addressed. You should not be surprised if there are some complications following your procedure. Complications following any type of surgical procedure are common. However, most complications you experience will be minor. They usually occur within six months of transplantation and will be recognized by your doctors.
One of the more common complications of transplantation is rejection. However, thanks to anti-rejection drugs, rejection episodes are less common and can be controlled.
Though such medications help prevent rejection, suppression of the immune system also makes transplant recipients more likely to get infections.
Talk to your transplant team immediately if you experience any of the following signs or symptoms of rejection or infection.
- Fever over 100°F (38°C)
- Flu-like symptoms such as chills, nausea, vomiting, diarrhea, tiredness, headache, dizziness, or body aches and pains
- Coughing up yellow or green mucus
- A dry cough that lasts for more than one week
- Severe diarrhea
- A burning feeling when you urinate
- Vaginal discharge or itching
- A wound that oozes fluid, does not heal, or feels warm
- Swelling, warmth, redness, pain, or tenderness of an arm or leg
- Pain or tenderness over your transplant site
- Retaining fluids or having sudden weight gain
- Shortness of breath
- Sudden rise in blood pressure
- Change in pulse rate
Kidney transplant recipients only:
- Change in the color or smell of urine
- A lower amount of urine
Liver transplant recipients only:
- Yellow color to the skin or eyes
- Light-colored or blackened stools
- Change in the color or smell of urine
What medications will I have to take following transplantation?
To help your transplant succeed, your doctor will use several different medications to slow down your body's immune system and make your body less likely to reject your transplanted organ. This process is called immunosuppression.
Although your doctor will work to prevent rejection, it can still occur. If you experience a rejection episode, your doctor may decide to treat it with different or additional medications, or simply with a dose adjustment of the drug or drugs that you are already taking.
Sometimes medications such as antibiotics (used to prevent or treat infections) or anti-ulcer drugs (used to treat digestive problems) may be necessary. Many other medications may also be used but are not discussed here. Always ask your transplant team any questions you might have about the medicines you are prescribed.
Your biggest responsibility post-transplant is keeping your organ, and yourself, healthy. Proper adherence to your regimen is critical to your long-term health.
Medications commonly used in transplantation include:
Because some drugs may produce unwanted side effects, it is important that you ask questions and talk freely with your transplant team about how you are feeling.
What is Prograf® (tacrolimus)?
Prograf (tacrolimus capsules and injection) is an immunosuppressant approved for the prevention of rejection in people who have received a liver or kidney transplant. Anti-rejection medications like Prograf are essential to the success of transplantation. In fact, since approval for rejection prevention for liver transplantation in 1994, and for kidney transplantation in 1997, Prograf has helped more than 100,000 people.
Only physicians and facilities specializing in transplantation should manage patients taking Prograf. Anti-rejection medications may result in an increased possibility of developing an infection or lymphoma, a type of cancer.
In clinical studies, up to 20% of patients taking Prograf developed insulin dependent diabetes after transplant, but in some patients, after two years, insulin was no longer required. African American and Hispanic kidney transplant patients were at an increased risk.
Prograf has been associated with toxicity to the kidneys and nervous system. Common side effects are tremor, headache, high blood pressure, diarrhea, nausea and changes in kidney function.
Prograf should not be used in patients allergic to tacrolimus. Prograf injection should not be used in patients allergic to castor oil.
Prograf Prescribing Information 
Prograf Patient Information
Prograf Safety Information
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