Commonly asked questions
for your kidney transplant

Whether you are a transplant recipient or you are someone who wants to learn more about kidney transplants, you can find answers to many of your questions by taking a look at the following frequently asked questions.

We encourage you to speak with your doctor for more information.

Before your kidney transplant

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Why is a kidney transplant necessary?

Kidney transplants are necessary when illness or injury leads to organ failure.

What is transplantation?

Kidney 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
  • Heart
What diseases or conditions commonly lead to kidney transplants?
Adults

Common causes that may lead to kidney failure in adults are complications of diabetes (high blood sugar) and hypertension (high blood pressure). Other diagnoses that can 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 or 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
  • Changes in urination
  • Skin rash/itching
  • Dizziness/difficulty in concentration
  • Metallic taste in mouth/ammonia breath
  • Nausea/vomiting
  • Feeling cold
  • Fatigue
  • Shortness of breath

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 a kidney 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 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. 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 that 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 kidney donors with those awaiting a kidney 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.

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 kidney transplant is determined by such factors as severity of disease and time on the waiting list. When a kidney donor becomes available, the people for whom that kidney is a perfect match are identified, and the organ is offered to the recipient who has the most urgent need for the kidney, based on his or her current health status.

Why do waiting times vary around the country?

In addition to kidney donor 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.

The center will offer the first available kidney 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 kidney donors and deceased donor organ donation?
Deceased kidney transplant donation

Deceased donor kidney donation is donation of a kidney after a person dies. In 2012, over 90,800 people were waiting for kidney transplants, although thousands were left without a transplant because of organ shortages.

Living kidney transplant donation

Fortunately, waiting for a kidney transplant 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 be a kidney donor by sharing a kidney with a family member, spouse, or a friend. You can learn about it in greater detail in our Sharing Life (PDF).

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.

According to the Organ Procurement and Transplantation Network (OPTN) 5-year success rates for people who've received a kidney through living donation are approximately 13% higher than those who received a kidney from a deceased donor.

How is living kidney transplant 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.

If a transplant through living kidney donors 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) and speak with your transplant team.

What is the risk of living kidney donation to the donor?

The risks to kidney donors are low; however, kidney transplant 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 donation for the donor and any potential problems associated with having only one kidney.

To learn more about living donors, download Sharing Life (PDF) and speak with your transplant team.

What questions should I ask concerning finances?

Here are some important questions to ask before your surgery. Be sure to bring these with you to your meeting with your transplant financial coordinator.

  • What is the average cost for a transplant, including care required before and after the transplant?
  • Do the costs vary if I have a living donor?
  • Is treatment for my medical diagnosis covered?
  • Is there a pre-existing clause for my plan? If so, what are the terms?
  • Will my illness be considered a pre-existing condition?
  • Will I have to pay for a portion of the costs? If so, about how much?
  • Who will pay for my donor costs?
  • What financial coverage does the hospital accept (Medicare, Medicaid, private insurance, etc.)?
  • What can I do if my financial coverage runs out?
  • Are there deductible and co-payment amounts? If yes, what are they?
  • Does my plan cover expenses such as travel, food, and lodging while I am at the transplant center? Will it cover these expenses for my family?
  • If my plan covers travel, food, and lodging costs, how much will it pay? Will it cover the cost of a person to come with me?
  • Will my insurance require pre-approval for any of my treatment?

During your kidney transplant

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Will my kidney 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 uncontrolled blood pressure, then your transplant team would consider removing your own kidneys. One of the most common medical conditions requiring "native nephrectomy" (removal of your kidneys) is congenital reflux disease.

What is kidney transplantation surgery like for the recipient?

Regardless of whether the kidney is from a living or deceased donor, kidney transplant surgery for the recipient involves general anesthesia, and treatment with anti-rejection drugs.

  • 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 3 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 to 6 months.
What are the potential complications of a kidney transplant for the recipient?

It is important to remember that a kidney transplant 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.

One of the more common complications of a kidney transplant is rejection. However, thanks to anti-rejection drugs, rejection episodes are less common and can usually be managed.

Medications that help prevent rejection suppress the immune system which makes patients more susceptible to infection.

Talk to your transplant team immediately if you experience any of the following signs or symptoms:

  • 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
  • Lower amount of urine

After your kidney transplant

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What can I expect to experience post-kidney transplant?

Your new kidney will start working as soon as your blood flows through it, but sometimes it takes a few weeks before the kidney starts working. This is called delayed graft function.

After the transplant, the recipient 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 a normal lifestyle when they have recovered and their physician has determined that it is appropriate for them to resume normal activities.

It is important to note that even though you no longer have to go to dialysis several times each week, initially your days will now be scheduled with doctor's appointments, taking medications, and following your doctor's instructions.

Will I need to weigh myself, take my temperature, or take my blood pressure after surgery?

You may also need to perform several tests on a regular basis at home. Although specific tests vary, tests that are very important in helping to monitor the health of every transplant patient include temperature, weight, blood pressure, and pulse. Talk to your transplant team about tests you will need to perform, as well as additional questions you have or instruction you need.

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 kidney 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.

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-kidney transplant?

To help ensure your kidney 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 transplant kidney. 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 others may also be used but are not discussed here.

Always ask your transplant team any questions you might have about the medications your doctor has prescribed for you.

Your biggest responsibility after a kidney transplant is keeping your organ, and yourself, healthy. Proper adherence to your regimen is critical to your health.

Medications commonly used in kidney 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.