A kidney transplant is a surgical procedure to place a healthy kidney from a live or deceased donor into a person whose kidneys no longer function properly.

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The kidneys are two bean-shaped organs located on either side of the spine just below the rib cage. Each one is about the size of a fist. Their main function is to filter and remove excess waste, minerals and fluid from the blood by producing urine.

When your kidneys lose this filtering ability, harmful levels of fluid and waste accumulate in your body, which can raise your blood pressure and result in kidney failure (end-stage renal disease, which is also known as end-stage kidney disease). End-stage renal disease occurs when the kidneys have lost about 90 percent of their ability to function normally.

Common causes of end-stage renal disease include:

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• Diabetes

• Chronic, uncontrolled high blood pressure

• Chronic glomerulonephritis — an inflammation and eventual scarring of the tiny filters within your kidneys (glomeruli)

• Polycystic kidney disease

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People with end-stage renal disease need to have waste removed from their bloodstream via a machine (dialysis) or a kidney transplant to stay alive.

At the hospitals, health care professionals trained in many medical specialties work together as a team to ensure favorable outcomes from your kidney transplant.

Having all of this subspecialized expertise in a single place, focused on you, means that you're not just getting one opinion — your care is discussed among the team, your test results are available quickly, appointments are scheduled in coordination, and your transplant care team works together to determine what's best for you.

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Why it's done

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A kidney transplant is often the treatment of choice for kidney failure compared to a lifetime on dialysis. A kidney transplant can treat chronic kidney disease with glomerular filtration rate (GFR, a measure of kidney function) less than or equal to 20 ml/min and end-stage renal disease to help you feel better and live longer.

Compared to dialysis, kidney transplant is associated with:

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• Better quality of life

• Lower risk of death

• Fewer dietary restrictions

• Lower treatment cost

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Some people may also benefit from receiving a kidney transplant before needing to go on dialysis, a procedure known as preemptive kidney transplant.

But for certain people with kidney failure, a kidney transplant may be more risky than dialysis. Conditions that may prevent you from being eligible for a kidney transplant include:

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• Advanced age

• Severe heart disease

• Active or recently treated cancer

• Poorly controlled mental illness

• Dementia

• Alcohol or drug abuse

• Any other factor that could affect their ability to safely undergo the procedure and take the medications needed to prevent organ rejection

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Only one donated kidney is needed to replace two failed kidneys, making living-donor kidney transplantation an option.

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If a compatible living donor isn't available, your name may be placed on a kidney transplant waiting list to receive a kidney from a deceased donor.

How long you have to wait for a deceased donor organ depends on the degree of matching or compatibility between you and the donor, time on dialysis and expected survival post-transplant. Some people get a match within several months and others may wait several years.

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Risks

Kidney transplantation can treat advanced kidney disease and kidney failure, but it is not a cure. Some forms of kidney disease may return after transplant.

The health risks associated with kidney transplant include those associated directly with the surgery itself, rejection of the donor organ and side effects of taking medications (anti-rejection or immunosuppressants) needed to prevent your body from rejecting the donated kidney.

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Deciding whether kidney transplant is right for you is a personal decision that deserves careful thought and consideration of the serious risks and benefits. Talk through your decision with your friends, family and other trusted advisors.

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Complications of the procedure

Kidney transplant surgery carries a risk of significant complications, including:

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• Blood clots

• Bleeding

• Leaking from or blockage of the tube (ureter) that links the kidney to the bladder

• Infection

• Failure of the donated kidney

• Rejection of the donated kidney

• An infection or cancer that can be transmitted with the donated kidney

• Death, heart attack and stroke

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Anti-rejection medication side effects

After a kidney transplant, you'll take medications to help prevent your body from rejecting the donor kidney. These medications can cause a variety of side effects, including:

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• Acne

• Bone thinning (osteoporosis) and bone damage (osteonecrosis)

• Diabetes

• Excessive hair growth or hair loss

• High blood pressure

• High cholesterol

• Increased risk of cancer, particularly skin cancer and lymphoma

• Infection

• Puffiness (edema)

• Weight gain

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How you prepare

Choosing a transplant center

If your doctor recommends a kidney transplant, you may be referred to a transplant center. You're also free to select a transplant center on your own or choose a center from your insurance company's list of preferred providers.

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When you're considering transplant centers, you may want to:

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• Learn about the number and type of transplants the center performs each year

• Ask about the transplant center's kidney transplant survival rates

• Compare transplant center statistics through the database maintained by the Scientific Registry of Transplant Recipients

• Find out if the center offers paired donation or donation chain programs that might increase your chances of receiving a living-donor kidney

• Understand the costs that will be incurred before, during and after your transplant. 

• Assess the center's commitment to keeping up with the latest transplant technology and techniques, which indicates that the program is growing

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Evaluation

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After you've selected a transplant center, you'll be evaluated to determine whether you meet the center's eligibility requirements for a kidney transplant.

The team at the transplant center will assess whether you:

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• Are healthy enough to have surgery and tolerate lifelong post-transplant medications

• Have any medical conditions that would interfere with transplant success

• Are willing and able to take medications as directed and follow the suggestions of the transplant team

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The evaluation process may take several days and includes:

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• A thorough physical exam

• Imaging scans, such as X-ray, MRI or CT scans

• Blood tests

• Psychological evaluation

• Any other necessary testing as determined by your doctor

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After your evaluation, your transplant team will discuss the results with you and tell you whether you've been accepted as a kidney transplant candidate. Each transplant center has its own eligibility criteria. If you aren't accepted at one transplant center, you may apply to others.

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What you can expect 

Before the procedure

Finding a match

A kidney donor can be living or deceased, related or unrelated to you. Your transplant team will consider several factors when evaluating whether a donor kidney will be a good match for you. In Turkey, only Kidney Transplant from a living donor are allowed for foreign patients, they might be related (family member to the fourth degree) or unrelated.

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Living kidney donation

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Finding a willing living kidney donor is an alternative to waiting for a compatible deceased-donor kidney to become available.

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Family members are often the most likely to be compatible living kidney donors. But successful living-donor transplants are also common with kidneys donated from unrelated people, such as friends, co-workers or religious congregation members.

Paired donation is another type of living kidney donation if you have a willing kidney donor whose organ is not compatible with you or does not match well for other reasons. Rather than donating a kidney directly to you, your donor may give a kidney to someone who may be a better match. Then you receive a compatible kidney from that recipient's donor.

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In some cases, more than two pairs of donors and recipients may be linked with a non-directed living kidney donor to form a donation chain with several recipients benefitting from the non-directed donor's gift.

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Staying healthy

Whether you're waiting to find a compatible donor or your transplant surgery is already scheduled, work to stay healthy. Being healthy and as active as you're able can make it more likely you'll be ready for the transplant surgery when the time comes. It may also help speed your recovery from surgery. Work to:

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• Take your medications as prescribed

• Follow your diet and exercise guidelines

• Keep all appointments with your health care team

• Stay involved in healthy activities, including relaxing and spending time with family and friends

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Stay in touch with your transplant team and let them know of any significant changes in your health. 

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During the procedure

 

Kidney transplants are performed with general anesthesia, so you're not aware during the procedure. The surgical team monitors your heart rate, blood pressure and blood oxygen level throughout the procedure.

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After the procedure

After your kidney transplant, you can expect to:

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• Spend several days to a week in the hospital. 

• Have frequent checkups as you continue recovering. After you leave the hospital, close monitoring is necessary for a few weeks. 

• Take the necessary  medications prescribed by your doctor after your kidney transplant. 

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Results

After a successful kidney transplant, your new kidney will filter your blood, and you will no longer need dialysis.

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Kidney transplant success rates

According to the Organ Procurement and Transplantation Network:

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• Failure of the transplanted kidney is reported in about 4 percent of deceased-donor kidney transplant recipients within one year after transplant and in 21 percent of cases five years after transplant.

• Among living-donor kidney transplant recipients, failure rates are about 3 percent at one year and 14 percent at five years after transplant.

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Survival rates among kidney transplant recipients in U.S. transplant centers can be found online at the Scientific Registry of Transplant Recipients.

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If your new kidney fails, you can resume dialysis or consider a second transplant. You may also choose to discontinue treatment. This decision depends on your current health, your ability to withstand surgery and your expectations for maintaining a certain quality of life.

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