The goal of transplantation is to improve the quality of life for people with end stage renal disease (ESRD). Transplantation is not a cure, but an alternative to dialysis. Our goal is for the transplant recipient to achieve a level of activity and health comparable to a person of their age who does not have kidney disease.
Renal transplant does involve risk. Each individual has to consider their own set of circumstances and the recommendation of their physicians when making the decision to pursue transplant as a treatment option.
Potential recipients must be free of active infection or cancer. The medications that are taken to prevent rejection (immunosuppressants) decrease the immune system's response, and can make infection or cancer much worse. To make transplant safer for the recipient, a complete medical evaluation is performed. In some cases, the risk of taking transplant medications, in combination with other health problems, is so great that the patient and physician decide that transplant is not the best treatment for that individual.
The recipient, family, and close friends will be invited to an informational session to help decide whether transplant is the best treatment option. To proceed with the evaluation for transplant, a thorough general examination and a series of tests will be performed. These tests will inform the transplant team about the potential recipient's current health. If there are special risks they will be discussed. It is very important that the recipient be in the best health possible at the time of transplant.
Specifically, the following exams are completed to determine candidacy for transplant:
- History and physical exam
- Psychosocial Exam
- Extensive lab work and testing for hepatitis, HIV and other infectious diseases
- Blood tests to determine blood type and tissue type
- Cardiac evaluation if over 45 years old or a diabetic
- Chest x-ray
- Colonoscopy if over 50 years old
- Mammogram if a female over 40 years old
- Pap test and pelvic exam for females
- Mantoux test for tuberculosis
If any of this testing has recently been completed, it will probably not need to be repeated. Additional testing may be required, depending on the medical history and any symptoms the patient may be having.
If needed, vaccinations against pneumonia and hepatitis will be given.
Once it has been decided that kidney transplant is an appropriate therapy, the recipient will either be placed on the waiting list for a deceased-donor kidney, or relatives and friends can begin evaluation as living donors.
The transplant nurses can provide information to share with family members and friends, or they can contact the family by phone or mail. This program is called the Living Donor Program.
Recipient and donor evaluation can be as short as one month but may take longer, depending on circumstances. The surgery date will be set after both recipient and donor have been consulted. In some cases, the surgery is delayed to meet the donors work schedule or other considerations.
If there are no potential living donors the recipient will be placed on the national waiting list. The United Network for Organ Sharing (UNOS) manages the national waiting list. The information that is included on the national list is the listing date, tissue type antigens, blood type, and any antibodies.
While on the waiting list, blood must be drawn and sent to the immunology lab every three months to check the antibody level. This blood will also be used for screening with potential donors.
There is a national "point system" that takes many factors into consideration, including length of time on the waiting list and compatibility with available kidneys. This system helps make organ distribution as fair and effective as possible.
Many factors are involved in matching, such as length of time on the waiting list, blood type compatibility, and genetic matching. It is not possible to predict when you will receive the call; however, the average wait is about 3-5 years. Some recipients are called much sooner, and some much later.
When a matching kidney is available, the transplant nurse will call and check on the recipient's current health. The recipient will need to come to the hospital as soon as possible because there is a limited amount of time that the kidney can be stored. Frequently, more than one patient is called regarding the same kidney due to the limited storage time.
When they arrive at the hospital, blood will be drawn for a final crossmatch. Medication will be given to the recipient to prevent rejection (immunosuppressive medication). The crossmatch takes from six to eight hours to complete. During this time, the recipient will have a physical, and may need dialysis in preparation for the surgery. If the crossmatch results show compatibility, the operation will be performed.
The transplant will take from two to three hours. An incision is made in the lower pelvic area. The blood vessels of the kidney are attached to blood vessels of the leg, and the ureter is attached to the bladder. A catheter is inserted into the bladder, to make sure it drains properly after surgery, and to monitor urine output. The original kidneys remain in place and are not disturbed.
The average length of stay in the hospital is five days. Some patients are released a day sooner and some stay longer.
Some kidneys start to function immediately and others take several days or weeks to start functioning. Some recipients must undergo dialysis for a short period of time before the kidney starts to function.
The transplant nurses teach the recipient the important things to know about taking care of the kidney. It is very important that the recipient take the immunosuppresive medications that are prescribed, and continue with follow-up appointments so that complications can be detected and corrected early.
Several complications can occur after transplant. The most common complications are:
- Rejection - Rejection occurs when the body recognizes the transplanted kidney as not belonging, and tries to destroy it. There are different types of rejection. Most rejections can be treated and reversed. During a rejection, it may be necessary to do a kidney biopsy to identify the type of rejection, so the proper treatment can be started. Rejection can occur at any time, but the greatest risk of rejection occurs within the first three months after transplant. During these months, higher doses of immunosuppressive medications will be given to prevent rejection, and frequent clinic visits will be required. Occasionally rejection occurs years after transplant, so it is very important that clinic appointments and lab work continue.
- Infection - The drugs taken to prevent rejection can decrease the ability to fight infections. Infections in a transplant patient can be serious and even life threatening. It is very important to seek help if symptoms of an infection develop.
- Acute tubular necrosis - The new kidney may not start to function immediately. Some kidney recipients need to continue to dialyze for a week or two. During the time the recipient remains on dialysis, a kidney biopsy may be performed to make certain the kidney is still recovering from the transplant.
- Hypertension (high blood pressure) - High blood pressure after transplant is very common. Most patients' blood pressures can be controlled with changes in medications. Controlling weight, limiting salt in the diet and exercising will also help.
- Cancer - Transplant patients have a slightly higher risk of cancer than the general population. Skin cancers are the most common, but can be decreased by wearing sunscreen. After transplant it is very important to have routine cancer screening because early detection greatly improves the chance of cure.
Each case is different, but typically the recipients insurance company is billed and processes the charges according to the benefits. The charges related to the pre-transplant evaluation of both recipients and donors are billed at the time of transplant as well. Our financial counselor will help you sort this out when referred to our transplant center.
Some of the immunosuppresive (anti-rejection) medications are expensive. Most insurance plans will pay for prescribed medications, with a small co-payment. We advise our patients to discuss drug coverage with our financial counselor and social worker before transplant or changing insurance.
For more information about kidney transplantation, contact the transplant coordinators at 612-873-7700 or toll free at 1-888-345-0816.