Kidney Transplant

How a transplant is 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. A laboratory test will 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.

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 can usually be left where they are, unless they are causing a problem such as pain or infection.
• Second, blood vessels from your lower abdomen 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. This will usually be removed about six to 10 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 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. These types of medication are known as immunosuppressants. See living with a kidney donation for more information about this.

If you have a kidney from a living donor, it will usually start working straightaway. In around seven out of 10 people who have a kidney transplant from a deceased donor, the new kidney begins working immediately after surgery. However, transplanted kidneys sometimes take up to six weeks to start working properly. If this is the case, you will need to have dialysis during this time.

Most people can leave hospital after about seven to 10 days, but you will need to attend frequent appointments at the transplant centre so your kidney function can be assessed and so tests can be carried out to check how well your immunosuppressants 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 two or three months.

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

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 can arise from a number of factors:

• 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.

Both 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.

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 is often placed inside the affected artery to stop it narrowing again.

Obstruction of the 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 forming.

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 an estimated one in five 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:

• weight gain
• abdominal pain
• diarrhoea
• extra hair growth
• swollen gums
• bruising or bleeding more easily
• acne

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.

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, and in some cases fatal health 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.

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
• Kaposi’s sarcoma – a type of cancer that can affect both skin and internal organs
• lymphoma – a cancer of the lymphatic system 

You can help reduce your risk of skin cancer by avoiding exposure to the sun during the hottest part of the day and by applying complete sun block to your lips and all exposed areas of your skin every day, regardless of whether or not it is sunny.

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.

Living with a Kidney Transplant

The lifestyle advice below is usually recommended if you have had 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.

The NHS Smokefree website can provide support and advice to help you stop, and your GP will also be able to recommend and prescribe medication that can help. Read more about stopping smoking.

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 may cause food-borne infections such as listeriosis. For example, you should avoid:

• unpasteurised cheese, milk or yoghurt
• foods containing raw eggs (such as mayonnaise)
• undercooked 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:

• plenty of fruit and vegetables – 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 – read more about starchy foods
• some milk and dairy foods – read more about milk and dairy foods
• some meat, fish, eggs, beans and other non-dairy sources of protein – read more about meat, eggs and beans and pulses
• a small amount of food and drink high in fat and sugar – read more about fats and sugars

Also 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. See facts about salt for more information and advice.

Exercise and weight loss

Once you have made a sufficient physical recovery from the effects of surgery, it is recommended that you do regular physical activity.

Adults should do at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity every week.

The definition of moderate intensity physical activity is any activity that increases your heart and breathing rate and 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 probably unrealistic to meet these exercise targets immediately if you have not exercised much in the past. So you should aim to start gradually – possibly 15 to 20 minutes of exercise five times a week – and then build on it.

If you are overweight or obese it is recommended you try to achieve a healthy weight. This can be safely done through a combination of eating a healthy calorie-controlled diet and regular exercise.

It is normally recommended you aim for a body mass index (BMI) of between 18.5 and 25.

Read more about exercise and losing weight safely.

Alcohol, drugs and medications

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

Therefore, you should not exceed the recommended limits of:

• three to four units a day for men
• two to three units a day for women

Read more about alcohol units and get tips on cutting down.

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

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, as 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 with serious 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)
• headache
• aching muscles
• diarrhoea

Case Study 1 - 'I was a bag of emotions, both thrilled and terrified'

Ivy Ashworth-Crees talks about how much better her life is since her double kidney and pancreas transplant.

"About 32 years ago, I started to have diabetes and had to have insulin injections four times a day. I also had to work hard on my diet to make sure I didn’t eat too much sweet food.

"After about 25 years, I got kidney failure and, in 2003, I had to go on kidney dialysis. The kidney dialysis was very uncomfortable. It was a drain, having to do it four times a day, as well as having to have the diabetes injections four times a day. I felt like my life was on hold.

"I was on kidney dialysis for two years when they put me on the list to have a kidney transplant. The surgeon suggested that I could probably benefit from a kidney and a pancreas transplant, which meant I wouldn’t be a diabetic any more.

"When I got the phone call to say that I was going to Manchester for the transplant, I was absolutely hysterical. I was a bag of emotions, both thrilled and terrified.

"When I came round after the operation, I was in intensive care. I stayed there for about three or four days, then I was taken to the main ward.

"The most difficult part was getting out of bed and starting to walk. They walked me up and down the ward for weeks until my legs got strong enough. That was very, very difficult. The pain was very bad, but it’s all been worth it.

"The doctor asked me to try to reduce my weight, so I joined the gym. I enjoy swimming. I think it’s helping me to keep active. The only problem is that I can’t walk too far.

"It’s vital that I take the immunosuppressant drugs. If I don’t, my body could reject the kidney and pancreas. I have to take them for the rest of my life.

"My life’s changed dramatically. I now take it for granted that I can eat what I want, including chocolates! I’m back at work, I don’t have an injection after my meals, I don’t have to rush home for dialysis and my kidneys and pancreas are working well.

"I feel blessed that I’ve been through this operation and it’s worked so well."