Kidney Transplant Journey

Living Donor Program   Kidney Transplant Outcomes   Access FAQs

A kidney transplantation truly is a journey, with distinct steps before, during and after the surgical procedure.  Though each patient case is unique, the three key steps in the transplant process typically include patient evaluation, preparation for transplant surgery and post-surgical care.

A patient’s physician determines when a patient is a candidate for a donor kidney. Once a patient is placed on the kidney transplant list, the search begins for a new kidney. There are three categories of potential organ donors – living related, living-unrelated and deceased donors.

  • A living-related donor is a blood relative of the recipient, such as a mother, father, brother, sister, child, cousin, aunt or uncle.
  • A living-unrelated donor may be a spouse, in-law or friend.
  • A deceased donor is someone who has been declared dead and whose relatives have agreed to donate their loved one’s kidney to save a (life).

If a living-donor organ is not available, the patient is placed on a national waiting list for a deceased donor kidney.

Establishing Compatibility

To make sure that a transplant has a greater chance for success, the donor kidney is checked for compatibility by using three important blood tests:

  • Blood Type (A, B, O)
  • Crossmatch
  • Human leukocyte antigens (HLA)

If a potential donor is found compatible in blood type, crossmatch and HLA tissue, then the donor evaluation can move forward. A matched donor can donate directly to the intended recipient. If no matched donors are available, living donors can enter a "paired exchange" which allows unmatched pairs all over the country to donate to one another so that each recipient can receive a living donor kidney instead of waiting years for a deceased donor kidney. If there are no other potential living donors, the recipient will be placed on the UNOS waiting list.

Once the transplant team confirms you are eligible to receive a new kidney, it is up to you to make the decision to proceed. Talk with your transplant team and family — make sure you ask questions and that you fully understand what the procedure entails and how a transplant will impact your life going forward.

Medical Evaluation

After you have decided to go ahead with kidney transplantation, the next step is to have a complete medical examination and a series of diagnostic tests to determine whether or not you are a good candidate, including:

  • Comprehensive history and physical examination by a transplant nephrologist
  • Surgical evaluation by a transplant surgeon
  • Evaluation by a transplant dietitian
  • Evaluation by a transplant social worker to assess family or other support systems that may be necessary to ensure proper care post-operatively
  • Chest X-ray to check the lungs for disease
  • Cardiovascular tests – EKG – to evaluate the condition and strength of your heart
  • Blood tests consisting of blood chemistry, kidney function and immune system test
  • Ultrasound to look at your kidneys and surrounding structures
  • Transplant psychiatric evaluation in order to determine your understanding of the benefits and risks as they were explained to you

Typical kidney transplant surgery takes from two to four hours. A healthy kidney (from either a living or deceased donor) is surgically placed in the pelvis of a patient with end-stage renal disease. Blood flow is established by connecting the artery and vein of the transplanted kidney to the recipient’s iliac vessels. These are the blood vessels that supply blood to the lower abdomen and legs. Urinary flow is then re-established by connecting the transplant kidney ureter to the recipient bladder.

Complicated cases (for example, patients who have had multiple previous surgeries or have unusual anatomy) may require placement of the kidney in other locations in the abdomen and use of different blood vessels. These situations also require significantly more time in the operating room.

Once blood flow is established in the new transplant, the kidney will begin filtering, removing waste and producing urine. The native kidneys are usually not removed and will no longer function. Most kidneys will begin to function within 24-48 hrs. However, up to 30 percent of kidneys, particularly those from deceased donors may take several days to weeks before working normally.

Possible complications include:

  • Your body may reject the donor kidney.
  • The daily medication to combat organ rejection that is required for life may have side effects.
  • You may have an increased susceptibility to infection as a consequence of immunosuppressive medication.

What to Expect After Surgery

After your surgery, the Piedmont Transplant Institute team will follow you closely. You will be required to take immunosuppressive medication to help prevent rejection of the kidney transplant.

Immunosuppressants cause the body to lower its defenses and accept the new organ, but in doing so make you more vulnerable to some infections. The tradeoff is necessary to maintain function of your new kidney.

Possible Infections
The most common infections after transplant are viral, bacterial and fungal. Signs and symptoms of infection include:

  • Fever over 100°F
  • Flu-like symptoms, such as chills, headache, muscle aches, dizziness or fatigue
  • Cough or shortness of breath
  • Sore throat
  • Gastrointestinal discomfort, such as pain or burning during urination, uncommon frequent urination or foul-smelling urine
  • Pain over the transplant area
  • Skin irregularities, such as swelling, redness, a sore or wound that doesn't heal or continuing drainage from the wound

In addition, you need to keep an eye on signs and symptoms of acute rejection which can mimic some of the features of infection such as fevers and pain over the area of the transplant. A sudden decrease in urine output should also be reported your transplant coordinator as this is sometimes a sign of kidney dysfunction.

Living with a transplant is a lifelong process. Regular visits and frequent contact with the transplant team are essential. Piedmont Transplant Institute provides support every step of the way in your transplant journey, at a time when you need to focus your energy on treatment, recovery and return to health.