Introduction

Kidney transplant
Kidney transplant

A kidney transplant is the transfer of a healthy kidney from one person into the body of a person who has little or no kidney function.

The main role of the kidneys is to filter waste products from the blood and convert them to urine. If the kidneys lose this ability, waste products can build up, which is potentially life-threatening.

Loss of kidney function, known as end stage chronic kidney disease or kidney failure, is the most common reason for needing a kidney transplant.

It is possible to partially replicate the functions of the kidney using a blood filtering procedure known as dialysis. Howevere this can be inconvenient and time-consuming so a kidney transplant, when possible, is the treatment of choice for kidney failure.

Who can have a kidney transplant?

Most people who need a kidney transplant are able to have one, regardless of their age, as long as:

  • they are well enough to withstand the effects of surgery
  • the transplant has a relatively good chance of success
  • the person is willing to comply with the recommended treatments required after the transplant – such as taking immunosuppressant medication and attending regular follow-up appointments

Reasons why it may not be safe or effective to perform a transplant include having an ongoing infection (this will need to be treated first), severe heart disease, cancer that has spread to several places in your body or AIDS.

Around one in three people with kidney transplant failure is suitable for a transplant.

Kidney donations

Unlike many other types of organ donation, it is possible to donate a kidney while you are alive because you only need one kidney to survive. This is known as a living donation.

People who want to be considered as a kidney donor are tested very carefully to ensure they are a suitable donor and are fit for the operation needed to remove a kidney.

Ideally, living donations will come from a close relative because they are more likely to share the same tissue type and blood group as the recipient, which reduces the risk of the body rejecting the kidney.

Kidney donations are also possible from people who have recently died. This is known as deceased kidney donation. However, this type of kidney donation has a slightly lower chance of long-term success.

Read more about donating a kidney below.

Waiting for a kidney

People who need a kidney transplant, but do not have a suitable living donor, will have to wait until a suitable deceased donor kidney becomes available.

On average, the waiting time for a deceased donor kidney transplant is two to three years. Waiting times are so long because the demand for donated kidneys in the UK is far higher than the available supply of donors.

From April 2014 to April 2015, around 3,000 kidney transplants were carried out in the UK, but there were still more than 5,000 people on the waiting list for a kidney by the end of this period.

Kidney donors are particularly required from people of non-white ethnic origin because rates of kidney disease are especially high in people of South Asian, African and Caribbean ethnic origin. However there are not many donors from these communities.

Read more about the kidney transplant waiting list.

The transplant procedure

If you receive a kidney from a living donor, this will be a carefully planned operation.

If you are waiting for a deceased donor kidney, the transplant centre will contact you if a suitable kidney becomes available. This can happen at any time of the day or night. Staff at the centre will check you don't have any new medical problems and will ask you to go to the centre, where final checks will be performed to be sure the transplant should go ahead.

You will then have surgery to insert the new kidney and connect it to your blood vessels and bladder. The new kidney will be placed in the lower part of your abdomen (tummy). Your own kidneys will usually be left in place.

A kidney transplant is a major surgical procedure with a wide range of potential risks. In the short term, these risks include blood clots and infection. Longer term problems, which include diabetes and an increased risk of infections, are usually related to the medication that needs to be taken to reduce the chance of rejection.

Because of the risk of further problems, people who have had a kidney transplant require regular check-ups for the rest of their life.

Read more about how a kidney transplant is performed and the risks of a kidney transplant.

Living with a kidney transplant

Having a healthy lifestyle after a kidney transplant goes a long way to minimising the risk of complications.

Therefore, it’s recommended that you:

  • stop smoking if you smoke
  • eat a healthy diet
  • lose weight if you are overweight or obese
  • take steps to reduce your risk of developing infections

Read more living with a transplant.

How long do kidney transplants last?

There are a number of factors which affect how long a transplanted kidney may last. These include whether or not the kidney came from a living donor, how well the kidney is matched in terms of blood group and tissue type, the age of the person receiving the donation, and the overall health of the person receiving the donation.

Overall, average kidney survival times are:

  • 1 year – about 95%
  • 5 years – about 85-90%
  • 10 years – about 75%

If you have a kidney transplant that fails, you can usually be put on the waiting list for another transplant. You may need dialysis in the meantime.

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Waiting list

Ideally, a kidney transplant should be performed when testing shows the extent of damage to your kidneys is so great that you will require dialysis within six months.

However, because of the lack of available kidneys, it is unlikely you will receive a kidney donation at this time unless a family member or friend who has a similar tissue type to you is willing to make a living donation.

Most people with kidney failure need dialysis while they wait for a donated kidney to become available.

The average time a person spends on the waiting list for a kidney transplant is two to three years, although it can be shorter or longer than this.

How donations are allocated

Demand for donations from recently deceased people far outstrips supply so there are strict but necessary guidelines about how donations are allocated.

Children and young adults are generally given priority if a matched donation becomes available as they will most likely gain a long-term benefit from a donation.

For older adults, a scoring system is used to determine who should get a donation. The score is based on factors such as how long you have been on the waiting list and how well matched the donor is in terms of tissue type, blood group and age.

Waiting for a transplant

If you are on the waiting list for a kidney, the transplant centre will need to contact you at short notice once a kidney becomes available so you must inform staff if there are any changes to your contact details.

You should also inform staff if there are changes to your health – for example, if you develop an infection.

While waiting for a donated kidney to become available, it is important you stay as healthy as possible by:

  • eating a healthy diet – read more about healthy eating
  • taking regular exercise if possible – read more about exercise and getting fit
  • cutting down on alcohol – recommended limits for alcohol consumption are 14 units of alcohol a week
  • stopping smoking if you smoke – read more about stopping smoking

Make sure you always have an overnight bag ready for when the call comes and make arrangements with friends, family and work so you can go to the transplant centre as soon as a donor kidney becomes available.

There are Renal Transplant Units in Cardiff, Birmingham and Liverpool.

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How is it performed?

When a suitable donor kidney is found, the transplant centre will contact you. Staff at the centre will check you don't have any new medical problems and will ask you to go to the centre.

When you hear from the transplant centre:

  • do not eat or drink anything
  • take all current medicines with you
  • take a bag of clothes and essential items for your hospital stay

When you arrive at the transplant centre, you will be quickly assessed. Some of the tests you had at your initial assessment may be repeated to ensure no new medical conditions have developed. Tests will also be done to ensure the kidney is suitable for you.

The transplant procedure must be carried out as quickly as possible for the transplant to have the best chance of success. After the medical team has confirmed the kidney is in good condition and is suitable, you will be given the general anaesthetic and taken to the operating theatre.

The operation

The kidney transplant procedure involves three main stages:

  • First, an incision (cut) is made in your lower abdomen (tummy), through which the donated kidney is put into place. Your own kidneys will usually be left where they are, unless they are causing a problem such as pain or infection.
  • Second, nearby blood vessels are attached to the blood vessels of the donated kidney. This is to provide the donated kidney with the blood supply that it needs to function properly.
  • Finally, the ureter (the tube that carries urine from the kidney to the bladder) of the donated kidney is connected to your bladder.

A small plastic tube called a stent may be inserted into the ureter to help ensure a good flow of urine initially. This will usually be removed about six to 12 weeks later during a minor procedure called a cystoscopy.

When the kidney is properly in place, the incision in your abdomen will be closed with surgical staples, stitches or surgical glue.

Although the procedure may sound relatively straightforward, it is very demanding and complex surgery that usually takes around three hours to complete.

After the operation

Once you have recovered from the effects of the anaesthetic, it is likely you will feel some pain at the site of the incision. Painkillers will be provided if necessary.

After the operation, you will immediately begin treatment with medication designed to prevent your immune system from rejecting your new kidney. See living with a kidney donation for more information about this.

Most transplanted kidneys will start working immediately, particularly if they come from a living donor, although sometimes they may take a few days or weeks to work properly. If this is the case, you will need to have dialysis during this time.

Most people can leave hospital in about a week, but you will need to attend frequent appointments at the transplant centre so your kidney function can be assessed and tests can be carried out to check how well your medications are working.

For the first few weeks after surgery, you may need to have two to three appointments a week. However, over time, your appointments will become less frequent. After a year, as long as you do not have any serious problems, you should only have to attend the centre once every few months.

After kidney surgery, you should be able to return to work and normal activities within a few months, provided you make good progress.

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Risks

Although rates of serious complications have fallen sharply in the last few decades, kidney transplants – like any other type of surgery – are not risk free.

The risks of a kidney transplant include:

  • risks related to the procedure itself
  • risks related to the use of immunosuppressant medications (medications that reduce the activity of your immune system)
  • risks related to something going wrong with the transplanted kidney

Most complications occur in the first few months after a transplant, but complications can still develop after many years.

Some of the main short-term and long-term complications of a kidney transplant are discussed below.

Short-term complications:

Infection

Minor infections, such as urinary tract infections (UTIs), colds and flu, are common after kidney transplants.

Potentially more serious infections, such as pneumonia and cytomegalovirus, can occur and may require treatment in hospital.

Blood clots

Blood clots can develop in the arteries that have been connected to the donated kidney. This is estimated to occur in around one in every 100 kidney transplant cases.

In some cases, it may be possible to dissolve the blood clots using medication, but it is often necessary to remove the donated kidney if its blood supply is blocked.

Narrowing of an artery

Narrowing of the artery connected to the donated kidney, known as arterial stenosis, can sometimes occur after a kidney transplant. In some cases, it can develop months or even years after the transplant.

Arterial stenosis can cause a rise in blood pressure. The artery often needs to be stretched to widen it, and a small metal tube called a stent may be placed inside the affected artery to stop it narrowing again.

Blocked ureter

The ureter (the tube that carries urine from the kidney to the bladder) can become blocked after a kidney transplant. It can be blocked soon after the transplant, for example by blood clots, or this can happen months or even years later, usually due to scar tissue.

It may be possible to unblock the ureter by draining it with a small tube called a catheter. Sometimes surgery may be required to unblock the ureter.

Urine leakage

Occasionally, urine may leak from where the ureter joins the bladder after surgery. This usually occurs during the first month after surgery. The fluid may build up in the abdomen or leak through the surgical incision.

If you develop a urine leak, you will usually need to have further surgery to repair it.

Acute rejection

Acute rejection means the immune system suddenly begins to attack the donated kidney because it recognises it as foreign tissue.

Despite the use of immunosuppressants, acute rejection is a common complication in the first year after a transplant, affecting up to one in three people.

In many cases, acute rejection does not cause noticeable symptoms, and is only detected by a blood test.

Acute rejection can often be successfully treated with a short course of more powerful immunosuppressants.

Long-term complications:

Immunosuppressant side effects

Immunosuppressants prevent your body's immune system from attacking the new kidney, which would cause the transplanted kidney to be rejected.

A combination of two or three different immunosuppressants is usually taken long term.

These can cause a wide range of side effects, including:

  • an increased risk of infections
  • an increased risk of diabetes
  • high blood pressure
  • weight gain
  • abdominal pain
  • diarrhoea
  • extra hair growth or hair loss
  • swollen gums
  • bruising or bleeding more easily
  • thinning of the bones
  • acne
  • mood swings
  • an increased risk of certain types of cancer, particularly skin cancer

The doctor in charge of your care will be trying to find the right dose that is high enough to 'dampen' the immune system sufficiently to stop rejection, but low enough that you experience very few or no side effects.

Finding the optimal dose to achieve both goals is often a difficult balancing act. It may take several months to find the most effective dose that causes the least amount of side effects.

Side effects should improve once the right dosage is identified. Even if your side effects become troublesome, never suddenly stop taking your medication because your kidney could be rejected. Speak to your GP or transplant team for advice.

Diabetes

Diabetes is a common complication of having a kidney transplant.

Diabetes is a lifelong condition that causes a person's blood sugar level to become too high. Some people develop it after a kidney transplant because, as they no longer feel unwell they eat more and gain too much weight. Some types of immunosuppressants can also make you more likely to develop diabetes.

Symptoms of diabetes include:

  • feeling very thirsty
  • going to the toilet to urinate a lot, especially at night
  • tiredness

Diabetes can often be controlled using a combination of lifestyle changes, such as changes to your diet, and medication. Read more about treating diabetes.

High blood pressure

High blood pressure is also a common long-term complication of a kidney transplant.

Many people who require a kidney transplant already have an increased risk of developing high blood pressure and taking immunosuppressants can make the condition worse.

High blood pressure usually causes no noticeable symptoms but can increase your risk of developing other serious conditions, such as coronary heart disease, heart attacks and strokes.

Because of the risk of high blood pressure, you will have your blood pressure checked every time you attend one of your follow-up appointments. In addition to this you can check your own blood pressure at home with a simple device available from most chemists.

Read more about checking your blood pressure.

Cancer

The long-term use of immunosuppressants also increases your risk of developing some types of cancer, particularly types of cancer known to be caused by viruses (as you will be more vulnerable to the effects of infection).

These include:

  • most types of skin cancer - including melanoma and non-melanoma
  • Kaposi’s sarcoma – a type of cancer that can affect both skin and internal organs
  • lymphoma – a cancer of the lymphatic system

You can reduce your risk of skin cancer by avoiding exposure to the sun during the hottest part of the day and by applying complete sun cream to your lips and all exposed areas of your skin every day.

Your care team will be able to provide more advice on your individual risks, whether you require regular check-ups and any early signs to watch out for.

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Living with

The following lifestyle advice is usually recommended to help you stay healthy after a kidney transplant.

Stop smoking

If you smoke, it is strongly recommended you stop as soon as possible because smoking can reduce the life of your new kidney and can increase your risk of developing some types of cancer.

If you want to give up smoking a good first step is to contact Stop Smoking Wales on 0800 085 2219. Stop Smoking Wales hold details of local support services. These services offer the most effective support for people who want to give up smoking. Studies show you are four times more likely to give up smoking successfully if you do it with the help of the NHS.

Diet

Most people are able to enjoy a much more varied diet after a kidney transplant, although you may be advised to avoid some foods after the operation until the kidney is working properly.

During the early stages after a transplant, while you are on higher doses of immunosuppressant medication, you should avoid eating foods that carry a high risk of food poisoning, including:

  • unpasteurised cheese, milk or yoghurt
  • foods containing raw eggs (such as mayonnaise)
  • undercooked or raw meats, fish and shellfish

Once your kidney is working properly and the best immunosuppressant dose for you has been identified, you will usually be advised to follow a generally healthy diet as this can help reduce your risk of complications such as diabetes.

A healthy diet should consist of:

  • at least five portions of fruit and veg a day
  • plenty of potatoes, bread, rice, pasta and other starchy foods; ideally you should choose wholegrain varieties
  • some milk and dairy foods
  • some meat, fish, eggs, beans and pulses and other non-dairy sources of protein

Avoid food that contains high levels of salt, as salt can cause high blood pressure, which can be dangerous in people with a kidney transplant.

Exercise and weight loss

Once you've started to recover from the effects of surgery, you should try to do regular physical activity.

Adults should do at least 150 minutes (2 hours and 30 minutes) of moderate-intensity every week. This includes any activity that increases your heart and breathing rate - it may make you sweat but you are still able to hold a normal conversation.

Examples include:

  • fast walking
  • riding a bike on level ground or with few hills
  • swimming
  • tennis

Choose physical activities that you enjoy, as you are more likely to continue doing them.

It is unrealistic to meet these exercise targets immediately if you have not exercised much in the past. You should aim to start gradually and then build on it.

If you are overweight or obese you should try to achieve a healthy weight. This can be safely done through a combination of eating a healthy, calorie-controlled diet and regular exercise. Aim for a body mass index (BMI) of between 18.5 and 25.

Read more about exercise.

Alcohol, drugs and medications

Regularly drinking alcohol above the maximum limits can raise your blood pressure, which can be dangerous in people with a kidney transplant.

To keep your risk of alcohol-related harm low, the NHS recommends:

  • not regularly drinking more than 14 units of alcohol a week
  • if you drink as much as 14 units a week, it's best to spread this evenly over three or more days
  • if you're trying to reduce the amount of alcohol you drink, it's a good idea to have several alcohol-free days each week

Regular or frequent drinking means drinking alcohol most weeks. The risk to your health is increased by drinking any amount of alcohol on a regular basis.

Alcohol is also high in calories, so you will gain weight if you drink regularly. Being overweight will also increase your blood pressure.

You should also avoid taking any illegal drugs after a kidney transplant, as they can damage your kidneys, cause a sudden rise in blood pressure and react unpredictably with your immunosuppressant medications.

Finally, always check with your care team before taking any medication, including over-the-counter medication and herbal remedies such as St John's wort. Some medications could be potentially harmful if you have had a kidney transplant and are taking immunosuppressant medication.

Immunosuppressants and infection

If you have a kidney transplant, you will usually need to take immunosuppressant medications for the rest of your life to prevent your body's immune system from attacking the new kidney.

Widely used immunosuppressants include:

  • tacrolimus
  • ciclosporin
  • sirolimus
  • azathioprine
  • mycophenolate
  • prednisolone

However, taking immunosuppressive medications on a long-term basis will weaken your immune system and make you more vulnerable to infections, so you will need to take extra precautions against infection:

  • Avoid contact with people you know currently have infections, such as chickenpox or influenza (flu).
  • Practise good personal hygiene – wash your hands regularly with soap and hot water, particularly after going to the toilet and before preparing food and eating meals.
  • If you cut or graze your skin, clean the area thoroughly with warm water, dry it, then cover it with a sterile dressing.

Also ensure your vaccinations are up to date, although you will not be able to have any vaccines that contain live viruses, such as the measles, mumps and rubella (MMR) vaccine.

When to seek medical advice

If you think you may have an infection, contact your GP or transplant centre for advice. Prompt treatment may be required to prevent serious complications developing.

Symptoms of infection include:

  • a high temperature (fever) of 38C (100.4F) or above
  • headache
  • aching muscles
  • diarrhoea
  • vomiting
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Donation Process

Unlike many other types of organ donation, it is possible to donate a kidney while you are alive because you only need one kidney to survive. This is known as a living donation.

Ideally, living donations will come from a close relative because they are more likely to share the same tissue type and blood group as the recipient, which reduces the risk of the body rejecting the kidney. However donations from those who are not blood relatives are often possible.

Kidney donations are also possible from donors who have recently died. However, this type of kidney donation has a slightly lower chance of long-term success.

Who can be a living donor?

There is no upper age-limit for choosing to make a living kidney donation, but you will usually need to be 18 or over.

If you decide to donate one of your kidneys, you will need to attend a series of appointments so that:

  • your blood group and tissue type can be determined, to check your compatibility with potential recipients (see below)
  • the state of your kidneys can be checked
  • your general health can be assessed
  • tests can be carried out to see if you have any serious illnesses that could affect the donation, such as HIV or diabetes

This assessment procedure can take several months, and several visits to the transplant centre may be required.

Checking compatibility

One of the biggest risks of receiving a donated kidney is that your immune system will mistake the donated kidney for foreign tissue. If this happens, your immune system will attempt to destroy the kidney. This is known as rejection.

To minimise the risk of rejection, the kidney should ideally be donated by a donor to a recipient who shares the correct:

  • tissue type - human tissue carries a special genetic 'marker' or code, known as a human leukocyte antigen (HLA); ideally, you should receive your transplant from someone with a very similar HLA tissue type
  • blood group - as with tissue, red blood cells carry a specific antigen marker; ideally you should receive your transplant from someone with a compatible blood group, although in some transplant centres it may be possible to receive a transplant from someone with a different blood group

For these reasons, family members are usually the most suitable donors. Members of the same family often share the same genes so they are more likely to have matching HLA tissue types and blood groups.

Removing your kidney

Your kidney can be removed using:

  • laparoscopic (keyhole) surgery - a type of minimally invasive surgery that involves making several small incisions (cuts), through which fine instruments are used to remove the kidney
  • open surgery - where the kidney is removed through a single, larger incision

Laparoscopic surgery has the benefits of reduced scarring and a faster recovery time than open surgery, but it can only be performed by a surgeon with special expertise in the procedure so it may not always be an option.

Both types of operation are carried out under general anaesthetic, which means you will asleep during the procedure and won't experience any pain while it is performed.

See how kidney transplants are performed for information about what happens with your donated kidney once it is removed.

Recovery

You will usually need to stay in hospital for up to seven days if you have open surgery to remove one of your kidneys, whereas you can usually go home in 3-5 days after keyhole surgery.

You will need to take it easy for a few weeks after the procedure. You can usually return to work within about a month, but you may need more time off if you have an active and strenuous job.

Risks

As with any type of surgery, removing a kidney has risks. However, most complications associated with the procedure are relatively minor and treatable.

The most common problems that occur after the operation are infections - including wound infections, urinary tract infections and chest infections.

More serious complications, such as blood clots or severe bleeding, are less common and can be identified and treated quickly.

The risk of dying after surgery to remove one of your kidneys is very small, occurring in less than 1 in every 3,000 cases.

It's important to make sure you fully understand all risks associated with kidney donation before you consent to the procedure.

Donating your organs after you die

If you wish to donate any of your organs when you die, including your kidneys, make sure you join the NHS Organ Donor Register.

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The information on this page has been adapted by NHS Wales from original content supplied by NHS Choices.
Last Updated: 13/01/2016 11:09:27