About Kidney Transplant
Freedom from dialysis, improved life expectancy, and a better quality of life are the major benefits of transplantation compared with other renal failure treatment options. What follows are some frequently asked questions about kidney transplantation.
A successful kidney transplant is about five times more effective than dialysis in replacing kidney function. A transplanted kidney removes waste from the body and is better at maintaining the correct salt and water balance. Having a properly functioning kidney means freedom from the time and travel restraints of dialysis. You will no longer spend several hours a day, three days a week at dialysis. Most people that have had a transplant say they feel better and have more energy and stamina than they did on dialysis. They are able to return to a more normal and active lifestyle and most are able to return to school or work full time. Most importantly, patients with successful kidney transplants live longer.
Kidney transplantation offers many benefits, but it does have some risks. It is not always the right treatment option for everyone. These include:
- Uncertainty of success (the transplanted kidney may fail)
- Risk of anesthesia and surgery
- Risk of post-transplant complications and possible hospitalization
- Need for frequent follow-up and testing
- Risk of infection, malignancy, and cardiovascular disease
In addition, there are also risks associated with the drugs necessary to prevent the body from rejecting the transplanted kidney. These drugs that suppress your overall immune system are called immunosuppressants. They must be taken for the rest of your life or for as long as the kidney functions. Immunosuppressants are powerful drugs that can produce a number of side effects, including cancer, infection, and cardiovascular disease.
The decision to have a kidney transplant is an important one. A kidney transplant is not a cure for kidney disease. The decision to have a kidney transplant means that you are willing to make a life-long commitment to take care of yourself and your new kidney.
Frequently Asked Questions
Donor kidneys come from two sources: living people or from someone that has died and whose family has consented that their organs be used for transplantation (also called a deceased organ donor).
In a living donor transplant, a family member, spouse or a friend donates a kidney to the recipient. Any potential living kidney donor is thoroughly evaluated to make sure that he or she is healthy enough to donate. The steps to living kidney donation can be found here.
If a patient has a family member or friend who would like to donate but they are not the same blood type, it is possible to arrange a swap through the Kidney Paired Donation Program.
The transplant evaluation consists of a review of your medical records and a complete physical examination by the transplant nephrologist and surgeon. You will have a chest X-ray and EKG if you have not had one in the past year. Blood work will be drawn for routine studies and infectious disease testing. Further testing is performed as necessary depending on underlying medical conditions.
You will be given information concerning the transplant process, and have an opportunity to ask questions. You are encouraged to learn as much as possible about transplantation before making a decision about having a kidney transplant. The members of the transplant team will explain the benefits and risks of transplantation.
The members of the transplant team will also discuss any special medical problems you have that may require additional evaluation. These conditions could include diabetes, heart disease, infections, bladder dysfunction, ulcer disease, gallstones, or a neurological problem such as a stroke. If you have any of the above, additional testing may be needed to determine that you are healthy enough to have the transplant surgery. Female candidates will need to have documentation of an annual Pap test and mammogram.
After your evaluation, members of the transplant team will meet to review your case at Transplant Candidate Review Meeting, which is held twice a month. They will decide as a group if further testing is necessary before any decision regarding transplantation can be reached. What Does "Tissue Typing" Mean?
For your new kidney to work properly, you and the donor's kidney must be "compatible." To determine compatibility, three tests are done:
- ABO (blood type) Compatibility
- Crossmatch Compatibility
- Human Leukocyte Antigens (HLA) Tissue Typing
ABO (blood type) Compatibility
Initially, your blood is tested to be sure that you are the same or a compatible blood group with the donor. In the case of kidney transplants, matching is done for blood group (O, A, B, AB). An O donor can donate to an O, A, B, or AB patient, whereas an O patient can only receive an O kidney. The Rh factor (positive or negative) is not a consideration in transplantation. Blood Type
Can Receive a Kidney From:
Can Donate to:
O, A, B, AB
AB, A, B, O
Crossmatch CompatibilityThe second absolute immunological requirement for transplantation is a negative crossmatch test. This test detects antibodies directed against the donor cells. In the laboratory, a small amount of blood from the recipient is mixed with a small amount of blood from the donor. If the cells live, the crossmatch is negative. If the cells die, this is a positive crossmatch. If the crossmatch is positive, the transplant cannot occur. ABO compatibility and a negative crossmatch test are the minimum immunologic requirement for transplantation. Approximately one third of potential donors are incompatible with their intended recipients. If this happens, we will explore Kidney Paired Donation options.
Once you have been accepted, your name will be added to the National Kidney Transplant waiting list. The Maine Transplant Program is a member of the New England Organ Bank, a regional Organ Procurement Organization, and the United Network for Organ Sharing (UNOS). When a kidney becomes available, it is matched with a recipient according to a point system. The waiting time depends on many factors. If you do not have a living donor, you can expect to wait several years for a kidney. Learn more about the Kidney Allocation System.
When you are on the waiting list, a sample of your blood must be sent to the Maine Medical Center Immunogenetics Laboratory at certain times every month. If you are on hemodialysis, your unit will send the sample automatically. If you are not yet on dialysis, or you are doing home dialysis, we will help you arrange for the blood testing to be performed. The purpose of this test is to monitor your antibody level and use the blood to perform a crossmatch should a donor kidney becomes available for you. It is absolutely essential to keep this testing current as you will not receive a kidney offer if the sample is out of date.
When a kidney becomes available for you, one of our transplant coordinators will call you to come to Maine Medical Center without delay. You will first be called at home, then we will use the alternate numbers you have provided. Therefore, it is critical that your contact information as well as your insurance information be accurate and up-to-date. Please call your transplant coordinator if:
- You change your name (marriage), address, or telephone number;
- Your insurance coverage changes;
- Your dialysis schedule changes;
- You receive a blood transfusion; or
- You are hospitalized for any reason.
Please do not assume that the dialysis unit or your local doctor will call the transplant program. The toll free number is 1-800-870-5230. You may call your transplant coordinator at any time and leave a confidential voice mail message.
A number of complications are possible after surgery. There is no way to predict for sure which patients will have which problems. Your transplant team will do their best to reduce your chance of having complications and to treat them right away if you have any. Following instructions carefully and keeping your transplant team informed of any problems will help you return quickly to a normal, active life. Some possible complications are:
- Delayed graft function, which may briefly lead to the need for dialysis after transplant
- Anxiety and depression
- High blood pressure
- Weight gain
Your body's immune system protects you from infection by recognizing certain foreign material, like bacteria and viruses, and destroying them. Unfortunately, the immune system sees your new kidney as a foreign substance also. To prevent rejection, you must take anti-rejection medications, as prescribed, for the rest of your kidney's life.
Rejection is one of the more important concerns for kidney transplant recipients although is seen in only 1 person in 10 within the first year and in another 1 person in 10 within the following decade. Most rejection episodes cause no symptoms and are detected by changes in blood tests. Most importantly, most rejection episodes that occur early after transplantation are treatable. Failure of a transplant due to rejection is rare unless the individual has stopped taking their immunosuppressive medications.
You must understand that despite efforts to prevent rejection, it may still occur. Generally, rejection is treatable with medication and usually does not lead to immediate loss of the kidney. However, for some patients, one or more rejection episodes or complete failure of a transplanted kidney can occur. It helps to understand just why your body might want to reject a transplanted kidney.
After your transplant, you will be required to take a combination of drugs designed to suppress your immune system and prevent rejection of your new kidney. Some of the most frequently prescribed are:
The transplant nephrologist will determine the particular combination of drugs you will take after your transplant and discuss the side effects of each. In general, immunosuppressive therapy carries an increased risk of infection and cancer.