About kidney transplant surgery

Before surgery

• Every transplant hospital handles the process of being admitted and preparing for kidney transplant surgery differently. Talk to your doctor and transplant team to make sure you are on the same page.
• In any major surgery, including the transplant of a kidney, you may require a blood transfusion. It is important to talk to your doctor ahead of time about any potential concerns about the source of blood and know that many hospitals offer "autotransfusion," where you donate your own blood before surgery.
• When preparing for your surgery, make certain that you have a scale, thermometer, and blood pressure cuff at home. Your transplant team will instruct you to take your temperature after a kidney transplant. Post-kidney transplant, a fever can be one of the first signs of infection.Even though you no longer have to go to dialysis several times each week, the initial days after a kidney transplant will be busy with doctor's appointments, taking medications, and other instructions from your doctor.
• 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.
• In the days immediately following your transplant, you can expect to be tired. A kidney transplant 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, when your doctor feels you are ready.
• You should plan to exercise according to your transplant team's instructions, generally at least 5 days a week. They may suggest you start with something simple, like walking, and increasing your time and pace slowly to reach a minimum of 30 minutes a day.
• Complications can occur: if this happens, contact your doctor immediately.

During surgery

Regardless of whether the kidney is from a living kidney donor or deceased kidney donor, your surgery will involve general anesthesia, and will be followed by 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 donor kidney is placed into the space.
• The blood vessels of the donor kidney are sewn to your blood vessels.
• Then the surgeon connects the ureter to the bladder and closes the cut.
• This surgery usually takes about 3 hours.

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.

After surgery

After your transplant, your new kidney should work as soon as your blood flows through it. In some cases, it takes a couple of weeks before the kidney starts working. This is called delayed graft function.

To make sure everything went well, you'll be monitored in the recovery room for several hours and then moved to a step-down or transplant unit. Here, you'll be encouraged to get out of bed and walk as much as you can.

The average hospital stay is 4 to 7 days, depending on the function of your kidney. Most people who have a kidney transplant will return to normal activities and lifestyle within several weeks to months after receiving their kidney transplants.

Watching for a kidney rejection

It is important to remember that transplantation is a serious surgery and risks still remain — even years after kidney transplant surgery. One of the more common complications of transplantation is rejection. However, thanks to anti-rejection drugs, rejection episodes are less common and can usually be managed.

• If you notice any of the following symptoms, call your transplant team right away:
• Fever over 100°F (38°C)
• Flu-like symptoms such as chills, nausea, vomiting, diarrhea, tiredness, headache, dizziness, or body aches and pains
• Pain or tenderness over your transplant site
• Retaining fluids or having sudden weight gain
• Shortness of breath
• Rise in blood pressure
• Change in pulse rate
• Change in the color or smell of urine
• Decrease in urine output

Because rejection can occur without producing any signs or symptoms and may only be found during a regular office visit, it is important that you remember to keep all of your scheduled appointments and complete needed lab work.

As you know, kidney rejection is serious. That makes taking your anti-rejection medication directly as prescribed serious as well. Make sure you take the same anti-rejection medicine each time, unless your doctor tells you otherwise.

Watching for a kidney transplant infection

The medications you take to prevent kidney rejection work by slowing down your body's immune system. While they help to prevent your transplant from rejection, they also lower your body's ability to fight infections.

To help lower the risk for infection, you may be prescribed preventive medications. Because your risk for infection will go down over time, your transplant team may decide to lower the amount or dose of preventive medications that you require.

• Here are some things you can do to help further reduce your risk of infection:
• Scrub your hands often, especially before eating and after using the bathroom or touching animals.
• Keep fingernails short and always use clean nail clippers.
• Wear gloves when gardening to avoid bacteria in plants and soil.
• Practice good oral hygiene to prevent mouth sores.
• Avoid raw or partially cooked foods and unwashed fruits and vegetables.
• Avoid take-out and deli foods (foods sitting at room temperature can develop bacteria).
• Notify a member of your transplant team if you have been around anyone with a contagious illness (flu, chicken pox, etc.) or anyone who recently received a live vaccine, such as the polio vaccine.

Infections can become very serious and can even lead to death if left untreated.

• Contact your transplant team right away if you have any of the following 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 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