Kidney recipient questions

Should I be evaluated for kidney transplantation?

If you have end-stage kidney disease and are on chronic dialysis or you have chronic kidney disease approaching a function of 25% or less, you should be evaluated for a kidney transplant.

What are the advantages of kidney transplantation over chronic dialysis?

A kidney transplant’s superior ability to filter the blood on a continuous basis offers cleaner blood and improved long-term health over intermittent dialysis treatments. When compared with age and health matched people on dialysis, kidney transplant recipients show improved length and quality of life in many studies.

What are the disadvantages of kidney transplantation?

Kidney transplantation requires a surgery which contains the risk of potential operative complications. People who receive a kidney transplant are required take chronic medications which suppress their immune system and increase their risk for certain kinds of infections and cancer.

What is a transplant evaluation?

A transplant evaluation consists of a series of health interviews, physical examinations, and medical testing to assure that going forward with the transplant operation can be done as safely as possible. The evaluation process is determined by each potential recipient’s individual state of health but usually consists at minimum of cardiovascular, chronic infection, and cancer screening.

How can I be referred for a kidney transplant evaluation?

Most individuals are referred by their primary nephrologist who can give preliminary information about kidney transplantation and the contact information for a transplant center.

What is the difference between a living donor and a deceased donor kidney transplant?

A living donor kidney transplant comes from a relative, spouse, or friend who wants to give you specifically one of their kidneys. If you do not know a person who can donate a kidney, you can receive a kidney from a deceased donor. A deceased donor is an individual who has suffered terminal brain damage but whose body is kept alive with life support machines long enough to give the organs to people that need them.

What are the advantages of living donor kidney transplants over deceased donor kidneys?

Receiving a transplant from a deceased donor requires you to be put on a waiting list with other people who have no living donor. The time from being put on the waiting list until transplantation averages about four years currently in our region. Living donor kidney transplants often have better function and last longer than deceased donor kidneys.

How long will a kidney transplant function?

Unfortunately due to many unavoidable immunological factors most kidney transplants do not last indefinitely. Living donor transplants continue to function on average 20 years and deceased donor transplants for 12 years. There are multiple factors including blood pressure control, pre-existing medical conditions, immunological matching, and donor age which may influence the length of time your transplant functions.

How is the transplant surgery done?

An incision is made in the lower part of one side of your abdomen, the donor kidney is placed inside you, and the blood vessels and the ureter from the donor kidney are connected to your blood vessels and bladder. Your kidneys are typically not removed unless special circumstances are identified. Once all connections have been made, the incision is closed. The kidney transplant procedure takes approximately three to four hours to complete.

How long is the recovery period following the kidney transplant surgery?

Recovery time varies from individual to individual and expectations can be discussed specifically with your transplant team. Most kidney transplant recipients are discharged from the hospital four days after the surgery. The majority of kidney recipients are able to resume a normal, active lifestyle by 4-6 weeks following the transplant.

Kidney donor questions

What makes a good living donor?

While many people are willing to be living donors, not everyone has the qualities necessary to participate in living donation. Donors must be chosen carefully in order to avoid unsatisfactory outcomes. Individuals considered for living donation are usually between 18-60 years of age and in good general health. Potential living donors must be free from high blood pressure, diabetes, cancer, kidney disease, and heart disease. Donor body size compared to their recipient is taken into consideration. Most importantly, potential donors must be genuinely willing to donate.

How will I be evaluated to be a kidney donor?

You will begin your evaluation by discussing with the transplant center your genuine desire to donate a kidney free of coercion or financial incentive. Preliminary blood tests are then often performed to determine blood type and tissue compatibility with the kidney recipient. You will see your primary care physician for an evaluation of overall health. Further blood, urine, and imaging tests will then be performed to assess for previously unknown health conditions which could increase your risk to be a donor. Many donors come from other cities or even countries and most of the evaluation process can be done close to their own place of residence.

What are the risks of living donation?

Short term risks of living kidney donation involve the risk of the surgery required to remove one of your kidneys. Surgical complications are rare but most commonly include bleeding requiring transfusion, infection of the surgical incision or lungs, abnormal blood clotting, and allergic reactions to medications used in surgery. Following the removal of your kidney, the remaining kidney grows slightly to take over the work that two kidneys previously shared. Studies following living donors for many years after kidney removal show very few adverse health effects of living with one kidney. Living donation does not change life expectancy and most donors go on to live healthy and normal lives.

What are the benefits of living donation?

The donation of your kidney may dramatically improve the length and quality of life of someone you care about. Many donors experience a profound sense of well-being and emotional gain following kidney donation.

What expenses will I have being a living donor?

Medical expenses associated with your evaluation, surgery, hospitalization, and post-operative care will be covered by the transplant recipient’s insurance. You will need to have your own medical insurance to receive the annual physicals and health maintenance advised following living donation. Although federal law explicitly prohibits a recipient to pay a donor for an organ, your recipient may help cover expenses arising from travel, lodging, and lost wages.

How is the kidney donation surgery done?

The most common kidney removal procedure is done laparoscopically. Two or three small incisions are made close to the navel allowing the surgeon to pass a camera, surgical instruments, and a hand inside the abdominal cavity to visualize and remove a kidney. Occasionally, due to an unusual anatomy, an open surgical procedure must be preformed to remove the kidney. In this case, a five to seven inch incision is made on the side of the chest and upper abdomen to gain access to the kidney so it can be removed.

How long is the recovery period after kidney donation surgery?

Due to smaller incisions, the laparoscopic procedure requires a shorter recovery time than the open procedure. Most donors are discharged from the hospital three days following the laparoscopic surgery and are able to return to normal activity within four weeks. Recovery in the hospital following an open procedure usually requires five days and most donors are able to resume normal activity within twelve weeks.

Referring physician questions

What is the survival benefit of kidney transplantation compared with chronic dialysis?

Data analyzed from the USRDS have indicated that mortality risk for transplant recipients was 68 percent lower than mortality for patients receiving chronic dialysis on the waiting list. Annual death rate for transplant recipients was 3.8 per 100 patient-years as opposed to 6.3 per 100 patients-years for wait-listed patients.

What is the benefit of preemptive kidney transplantation?

Several recent studies indicate a progressive increase in risk for mortality and graft failure in patients receiving progressively longer periods of dialysis prior to transplantation. Preemptive transplantation has been associated with substantial improvements in patient and graft survival and with decreased risk for delayed graft function and acute transplant rejection.

When is the best time to refer a patient to the transplant center?

The strategy for referral to the transplant center should be aimed at optimizing a patient’s chance at receiving a preemptive transplant. Patients with chronic kidney disease whose GFR is 25ml/min or less are eligible to be listed with UNOS for an HLA zero-mismatched deceased donor. GFR must however be 20 ml/min or lower to begin to accrue time on the general waitlist. Preemptive transplants in patients who have living donors are usually performed at a GFR of 15ml/min. Based on the progression of a patient’s disease, we recommend referral to the transplant center for patients whose GFR is expected to be 25ml/min or less within the next six months.

If dialysis will be required prior to kidney transplantation, is there any benefit of one dialysis modality over another?

Studies comparing peritoneal dialysis to hemodialysis for transplant outcomes have been equivocal. While some data suggest increased rates of delayed graft function associated with hemodialysis other data suggest an increased risk for early graft thrombosis and infection associated with peritoneal dialysis. There is currently no consensus indicating one modality of dialysis is better than another prior to kidney transplantation.

What factors would prevent a patient from being a good candidate for kidney transplantation?

Medical reasons which may preclude kidney transplantation include severe cardiovascular disease, untreated current infection, active malignancy or chronic illness with short life expectancy, poorly controlled psychosis, and active substance abuse. Morbid obesity and habitual medical non-compliance are also factors associated with poorer outcomes following transplantation. All transplant candidates are reviewed on an individual basis by the transplant center.

Is there an age limit of eligibility for kidney transplantation?

Advanced age in itself is not a contraindication to kidney transplantation although careful medical screening for cardiovascular disease and malignancy is clearly required. Many elderly patients are transplanted successfully with acceptable long-term graft and patient survival.

When are kidney transplant recipients referred back to their primary nephrologist?

Patients are generally followed in the transplant center for 4-6 weeks prior to referral back to their primary nephrologist given stable medical condition. The transplant center is always available for re-consultation for any reason if needed.

The National Kidney Foundation has also prepared a helpful set of questions and answers regarding kidney transplantation.

Please click here for details.