Whether you are a transplant recipient or someone who wants 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).
We encourage you to speak with your doctor for more information.
Transplantation is necessary when illness or injury leads to organ failure.
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:
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.
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.
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:
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.
A kidney transplant is a treatment for kidney failure, not a cure. Even after surgery, you may still have the condition that caused your kidney to fail. For example, if your kidney failed because of diabetes, you will need to continue to take medications to control your blood sugar levels. Similarly, if your condition was the result of high blood pressure, you will be instructed to take your medications and follow a healthy, low-salt diet. You may also be instructed to take additional medications after transplant as well as follow a healthy, low-fat diet.
Your immune system produces certain kinds of proteins called antibodies that help protect your body from infectious agents such as viruses. After someone is exposed to an infectious agent and creates antibodies against it, the person is "immune" to the specific disease caused by the infectious agent. The antibodies created are then ready and waiting to destroy the infectious agent if it tries to invade the body again.
The body can also create antibodies against the tissues of other human beings such as those from blood transfusions, pregnancy, or an organ transplant. The antibodies that the body can create after these "sensitizing" events are called anti-human antibodies, or "alloantibodies."
If you have anti-human antibodies in your blood, they may react with the tissue type of a kidney donor, which means that you would not be able to receive a kidney from that donor. The antibodies in your blood would attack and damage the kidney immediately after transplantation. This is called "hyperacute rejection" which usually results in loss of the transplanted kidney.
Panel reactive antibody (PRA) tests or crossmatching is performed before the transplant. A "positive" crossmatch means that the transplant should not be done because of the high risk for hyperacute rejection. A "negative" crossmatch indicates that it is okay to proceed with the kidney transplant.
In certain situations, plasmapheresis may be used to remove antibodies from the blood. Like hemodialysis, plasmapheresis involves circulating part of a person’s blood through a machine. The blood is removed from the body and the formed elements of the blood (red blood cells, white blood cells, and platelets) are separated from the liquid part of the blood (the plasma which contains the antihuman antibodies and other plasma proteins). The plasma is then replaced with another suitable fluid, such as fresh frozen plasma and combined with the formed elements of the blood. The new combination is returned to the person’s body.
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 persons with kidney disease. There are two types 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 feeling tired. In addition, you must carefully watch your diet.
Hemodialysis filters harmful waste products from the blood. The blood is removed from your body through a catheter, which is 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 3 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 solution stays in your belly) of 4 to 6 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.
UNOS is a private, nonprofit organization that matches available organ donors with those awaiting transplant through the national Organ Procurement and Transplantation Network (OPTN). UNOS administers this program under contract with the US Department of Health and Human Services. Members of UNOS include all transplant programs, organizations that find organs, and tissue typing laboratories in the United States.
UNOS guarantees that all persons 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 person has been on the waiting list, blood type (A/B/O 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.
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.
In addition to organ availability, geography and population both contribute to waiting times. For example, waiting times may be longer in large metropolitan cities with large populations because of an increased need for certain organs, while waiting times may be shorter in smaller communities.
Your center will offer the first available organ to someone within its own area. If no match is found, the organ will then be shared on a regional and national level.
Deceased donor organ donation is donation of an organ or organs after a person dies.
Fortunately, waiting for an organ from a deceased donor isn’t the only option. For many people, living donation is an exciting possibility that enables a person who is still living to share an organ or portion of an organ with a family member, spouse, or a friend.
The benefits of living donation include:
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 A/B/O blood type and human leukocyte antigen (HLA) compatibility. After the surgery, the donor should 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.
To learn more about living donation, download
Sharing Life (PDF - 2.47 MB) and speak with your transplant team.
The risks to the donor are very low; however, kidney donation is major surgery. As with any surgery, there is potential for complications and infection. Your transplant team can provide more information on the specific risks of kidney transplantation for the donor and any potential problems associated with having only one kidney.
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.
In most cases, your old kidneys will not be removed. This is because even failed kidneys release chemicals that help your body work. However, if you have a kidney disease that causes ongoing problems, such as persistent kidney infections or intestinal blockage, then your transplant team would consider removing your own kidneys. The two most common medical conditions requiring "native nephrectomy" (removal of your kidneys) are congenital reflux disease and polycystic kidney disease.
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 6 months of transplantation and will be recognized by your doctors.
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.
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 4 to 7 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.
It is important to note that even though you no longer have to go to dialysis several times each week, initially your days will still be scheduled, with doctor’s appointments, taking medications, and just getting healthier.
If you are a woman of childbearing years, a kidney transplant should not alter your ability to have a child. It is often recommended that people wait approximately 2 years before conceiving a child in order to allow the body to get stronger and healthier. However, you should always discuss your decision to get pregnant with your healthcare provider.
Even if your period (menstruation cycle) stopped while you were going through dialysis, you could begin to start ovulating before your normal menstruation cycle resumes. Therefore, you should use birth control until you want to, and when it is advisable to, become pregnant. Please speak with your healthcare provider to determine which birth control is right for you.
It is important to understand how the medications you are taking may affect pregnancy and breast-feeding. Talk to your healthcare provider about your specific needs.
As part of your post-transplant care, you will have to weigh yourself daily. Rapid weight gain may be a sign of fluid retention. If you notice any changes, call your transplant coordinator.
Your transplant team will also instruct you to take your temperature three times a day (morning, afternoon, and evening). A fever can be one of the first signs of infection. You may also be asked to measure your blood pressure.
When preparing for your surgery, make certain that you have a scale, thermometer, and blood pressure cuff at home. These items may be given to you by your transplant coordinator.
In the days immediately following your transplant, you can expect to be tired. Transplantation is major surgery. However, you will begin to feel better and stronger each day—and you may be encouraged to resume physical activity, including work.
Exercise according to your transplant team’s instructions, generally at least 5 days a week. Start with something simple, like walking. Increase your time and pace slowly to reach a minimum of 30 minutes a day. Pace yourself so you don't feel rushed or overtired. Your transplant team will help you plan a proper exercise program.
To help ensure your transplant is a success, your doctor will intend for you to take 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 medication or medications that you are already taking.
Sometimes medications such as anti-infective (used to prevent or treat infections) or anti-ulcer (used to treat digestive problems) medications 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 medications your doctor intends for you to take.
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 medications 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) capsules?
PROGRAF is a prescription medicine used with other medicines to help prevent organ rejection in people who have had a kidney, liver, or heart transplant. PROGRAF is not for use with medicines called cyclosporines (Gengraf®, Neoral®, and Sandimmune®) and is not for use with a medicine called sirolimus (Rapamune®) in people who have had a liver or heart transplant. It is not known if PROGRAF is safe and effective when used with sirolimus in people who have had kidney transplants. It is not known if PROGRAF is safe and effective in children who have had kidney or heart transplants.
What is the most important information I should know about Prograf?
Prograf can cause serious side effects, including:
1. Increased risk of cancer. People who take Prograf have an increased risk of getting some kinds of cancer, including skin and lymph gland cancer (lymphoma).
2. Increased risk of infection. Prograf is a medicine that affects your immune system. Prograf can lower the ability of your immune system to fight infections. Serious infections can happen in people receiving Prograf that can cause death. Call your doctor right away if you have symptoms of an infection such as fever, sweats or chills, cough or flu-like symptoms, muscle aches, and/or warm, red, or painful areas on your skin.
Do not take PROGRAF if you are allergic to tacrolimus or any of the ingredients in PROGRAF.
Before you take PROGRAF, tell your doctor if you: plan to receive any live vaccines, have or have had liver, kidney or heart problems, are pregnant or plan to become pregnant. PROGRAF may harm your unborn baby and can pass into your breast milk. You and your doctor should decide if you will take PROGRAF or breastfeed. You should not do both.
Tell your doctor about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take: cyclosporine (Gengraf®, Neoral®, and Sandimmune®), sirolimus (Rapamune®), nelfinavir (Viracept®), telaprevir (Incivek®), boceprevir (Victrelis®) or amiodarone (Cordarone®, Nexterone®, Pacerone®). PROGRAF may affect the way other medicines work, and other medicines may affect how PROGRAF works. Know the medicines you take. Keep a list of your medicines and show it to your doctor and pharmacist when you get a new medicine.
How Should I Take PROGRAF?
Do not eat grapefruit or drink grapefruit juice while taking PROGRAF. Take PROGRAF exactly as your doctor tells you to take it. Take PROGRAF with or without food and the same way and time every day. If you take too much PROGRAF, call your doctor or go to the nearest hospital emergency room right away.
PROGRAF may cause serious side effects, including:
high blood sugar (diabetes), kidney problems, nervous system problems, high levels of potassium in your blood, high blood pressure, or heart problems (myocardial hypertrophy). Call your doctor right away if you have any of these symptoms: frequent urination, increased thirst or hunger, blurred vision, confusion, drowsiness, loss of appetite, fruity smell on your breath, nausea, vomiting, stomach pain, muscle tremors, numbness and tingling, headache, seizures, vision changes, shortness of breath, chest pain, feel lightheaded, or feel faint.
The most common side effects of PROGRAF® (tacrolimus) capsules are: tremors (shaking of the body); high blood pressure; kidney problems; diarrhea; headache; stomach pain; trouble sleeping; nausea; pain; weakness or low red blood cell count (anemia); infection; constipation; low levels of phosphate in your blood; swelling of the hands, ankles, or legs; high levels of fat or potassium in your blood; numbness or tingling in your hands or feet; fever; or low levels of magnesium in the blood.
Tell your doctor if you have any side effect that bothers you or that does not go away. These are not all the possible side effects of PROGRAF. For more information, ask your doctor or pharmacist. Call your doctor for medical advice about side effects.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.