Frequently asked questions about kidney transplantation
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.
- What is transplantation?
- Why is transplantation necessary?
- What diseases or conditions commonly lead to kidney transplantation?
- How will transplant affect my condition?
- What are antibodies and how will they affect my situation as I wait on the list?
- What is dialysis?
- What is the United Network for Organ Sharing (UNOS)?
- How is waiting list status determined?
- Why do waiting times vary around the country?
- What is the difference between living donor and deceased donor organ donation?
- How is living kidney donation done?
- What is the risk of living kidney donation to the donor?
- What is kidney transplantation surgery like for the recipient?
- Will my kidneys need to be removed before transplant?
- What are the potential complications of kidney transplantation for the recipient?
- What can I expect to experience during post-transplant recovery?
- Are there any concerns surrounding pregnancy?
- Will I need to weigh myself, take my temperature, or take my blood pressure after surgery?
- What can I expect my physical activity to be post-transplant?
- What medications will I have to take post-transplant?
- What is Prograf® (tacrolimus)?
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 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.
How will transplant affect my condition?
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.
What are antibodies and how will they affect my situation as I wait on the list?
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.
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 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.
What is the United Network for Organ Sharing (UNOS)?
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.
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.
Why do waiting times vary around the country?
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.
What is the difference between living donor and deceased donor organ donation?
Deceased donor organ donation
Deceased donor organ donation is donation of an organ or organs after a person dies.
Living donor kidney donation
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:
- Long delays waiting on national lists may be avoided
- The recipient may be in better health due to reduced time to transplant
- The donated organ may be healthier than one received from a deceased donor—and the transplanted kidney may begin to work faster
- Surgery can be scheduled for a time when both the donor and the recipient are in the best condition possible
How is living kidney donation done?
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 and speak with your transplant team.
What is the risk of living kidney donation to the donor?
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.
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 4 to 5 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 1 to 2 hours
- The recipient will usually be in the hospital for about 1 week and in most cases can return to his or her pre-transplant lifestyle in about 3 months
Will my kidneys need to be removed before 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.
What are the potential complications of kidney transplantation for the recipient?
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.
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 1 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
- Change in the color or smell of urine
- A lower amount of urine
What can I expect to experience during post-transplant recovery?
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.
Are there any concerns surrounding pregnancy?
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.
Will I need to weigh myself, take my temperature, or take my blood pressure after surgery?
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.
What can I expect my physical activity to be post-transplant?
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.
What medications will I have to take post-transplant?
To help ensure your transplant is a success, your doctor will prescribe 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 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 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)?
Prograf (tacrolimus capsules and injection) is an immunosuppressant approved for the prevention of rejection in people who have received a liver, kidney, or heart 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, for kidney transplantation in 1997, and for heart transplantation in 2006, Prograf has helped more than 100,000 people. Read Prograf and You to learn more about what Prograf can do for you.
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 recipients were at an increased risk.
Prograf® (tacrolimus) is indicated for the prophylaxis of organ rejection.
Important Safety Information About Prograf®
Prograf® (tacrolimus) is approved for the prevention of rejection in patients who have received a liver, kidney, or heart transplant. 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 22% of patients taking Prograf developed insulin-dependent diabetes after transplant, but in some patients, after two years, insulin was no longer required. Black 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, insomnia, high blood pressure, diarrhea, nausea, constipation, stomach pain, changes in kidney function, high blood sugar, low white cell count, infection, and high cholesterol/lipid levels.
Prograf should not be used in patients allergic to tacrolimus. Prograf injection should not be used in patients allergic to castor oil.
Only your healthcare professional can weigh the risks and benefits of a prescription medication and decide which medication is the right one for you.
Please see the full prescribing information.
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