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A kidney transplant is surgery to place a healthy kidney into a person with kidney failure.
Renal transplant; Transplant - kidney
Kidney transplants are one of the most common transplant operations in the United States.
One donated kidney is needed to replace the work previously done by your kidneys.
The donated kidney may be from:
The healthy kidney is transported in cool salt water (saline) that preserves the organ for up to 48 hours. This gives the health care providers time to perform tests to ensure that the donor's and recipient's blood and tissue match.
Living organ donors and deceased donors are the two sources of donors. Here’s a look at the different types of donors that fall within both categories.
Transplanting a kidney from a healthy individual into a person with kidney failure is called a living donation. Kidneys can come from living donors who may either be a living related donor (LRD), living unrelated donor (LURD) or a non-directed donor (not related to or known by the recipient). Live donor organs are usually better suited in terms of health, function and longevity in comparison to a non-living donor organ.
Donating a kidney is a precious gift to give and requires careful consideration from donors. UF Health Shands has been performing live kidney donor transplants since 1966, and our team is committed to providing expert care to you and your recipient.
Non-living donors are people who have suffered brain death or cardiac death and there is consent to be an organ donor, and a patient may have to wait years for a non-living donation.
There are three main blood tests that will determine if a patient and a potential donor are a kidney match. They are blood typing, HLA and cross-matching.
Blood typing is the first test that will take place. The four major blood types are type A, B, AB and O. The positive or negative feature in a blood typing is not a factor when determining compatibility between a donor and a recipient.
Blood type compatibility
It’s important to remember that blood type AB is called the universal recipient because they are compatible with any other blood type and blood type O is called the universal donor because they are compatible with any other blood type.
HLA, otherwise known as “tissue typing,” stands for human leukocyte antigen. Antigens are proteins on the cells, and there are six antigens that have been shown to be the most important in organ transplantation. Out of these six, three come from each parent. Half of your HLA markers are inherited from your mother and half from your father. Siblings from the same two parents have a 1-in-4 chance to match all six antigens. Identical twins are considered a “perfect match.” Two unrelated people can just happen to be a good HLA match as well, although it is much less likely.
Thanks to advanced medication known as immunosuppressive or anti-rejection medications, kidney transplants are very successful even if two people don’t have matching antigens.
To determine compatibility for a donor and recipient’s blood type, doctors can also perform a cross-matching test. In this test, blood from the donor and recipient are mixed, and if the results come back positive, the recipient’s antibodies have attacked and killed the donor’s cells. If the test comes back negative, the recipient’s antibodies did not respond to the donor’s, and therefore transplantation should be safe and the pair is compatible.
In the unfortunate case in which a donor and a recipient are incompatible, either because of incompatible blood types or incompatible cross-match, the potential recipient will stay on the non-living donor waitlist. Paired donation is an option that matches incompatible donor-recipient pairs with other pairs, and the recipients “exchange” donors.
The UF Health Shands Kidney Transplant Program offers paired exchange for all incompatible donor-recipient pairs in our center through the national UNOS/OPTN kidney paired donation system.
If time has passed without an acceptable paired exchange offer, there is another option for some pairs. In some ABO incompatible pairs, the antibodies against the donor cells can be removed by a special treatment to allow a recipient to accept the ABO incompatible transplant from their living donor. Additional testing is required to determine if this is an option.
The purpose of the donor medical evaluation is to ensure that the donation will not pose any risk during and after the operative procedure.
After expressing interest in donation, the donor is asked to complete a questionnaire. Any information shared will be kept confidential, and our living donor coordinator will contact the donor to discuss donation in more detail.
We recommend all donors have a primary care doctor before starting a donor evaluation to ensure continued medical follow-up after donation. We will complete a history and physical similar to an annual visit to a doctor as well as lab work to collect blood for testing. Cancer screens will be required, as per American Cancer Society guidelines.
Once the living donor coordinator has cleared the questionnaire, the donor is contacted for additional information via a phone interview with our living donor coordinator. A cross-match may be performed, if needed, and requires a blood draw from the donor and recipient. When compatibility is confirmed, the donor is scheduled for a visit to our transplant center for a series of appointments and medical tests.
Additional information is sent to the donor prior to the evaluation day and must be reviewed prior to the evaluation. The evaluation testing at our center takes one to two days, depending on required testing.
The evaluation for living donation includes:
The transplant nephrologist will go over all information on the health questionnaire and do a thorough physical exam. The transplant surgeon will complete a history and physical. The surgeon is looking at past surgical history, medical history, body habits and general history. The surgeon will also review CT scans that show the kidneys and the blood vessels that will need to be divided to remove the kidney during surgery.
On average, there is one artery bringing blood into a kidney and one vein letting blood leave the kidney. Having two arteries is the most common difference and can often still result in a safe and successful transplant.
In a few people, the anatomy (number of blood vessels or an unusual path of the blood vessels) may make donation more difficult than usual, and in rare cases, donation may not be considered safe. The goal is to confirm that transplantation surgery will be safe for the donor and recipient.
During the psychosocial interview, the donor speaks with our clinical social worker. This visit is a very important part of the living donor evaluation. The goals of the psychosocial interview are:
If a donor has a history of physiological issues, including depression, anxiety or any past psychiatric diagnosis — or has ever taken medication to treat these problems — he or she may be asked to see a transplant psychiatrist.
This is an educational class with our living donor nurse coordinator. We encourage all who wish to attend to ask questions in an informative and comfortable setting.
Multiple blood tests will be performed to assess general information about your health.
A urine test will be performed to check for obvious signs of kidney disease or infection. In addition, we may ask that donors collect urine at home for a 24-hour period. This collection gives us much more information on the kidneys’ functions. When a donor provides us with the urine collection, he or she will also have blood drawn.
An EKG evaluates whether your heart rhythm is normal and if you have any previous heart injuries.
If you are over age 50 or have a history that causes concern for possible heart disease, more extensive testing is done to rule out heart disease. This usually involves walking on a treadmill while your heart is monitored.
A chest X-ray is done to rule out lung disease or tumors.
If you are over age 45, you will need a screening to rule out colon cancer. This is a routine part of health maintenance and is recommended for all adults near this age. It can be ordered through your primary care doctor.
Also known as a CAT scan, this test evaluates the anatomy of the blood vessels going to and from the kidneys to analyze the kidney tissue, screen for kidney stones and examine the ureters draining the kidneys. This test helps our surgeons decide which kidney to remove.
During this test, an IV line is placed in your arm and a contrast solution is injected into the IV to help make the vessels clear to see. The contrast solution may give you a warm feeling when injected, and the procedure usually takes about an hour. Tell us if you have had a reaction to IV contrast in the past, as medications can be given a day or more prior to prevent these issues.
Also known as renal scintigraphy. During this test small amount of radiotracer material is used to evaluate your kidney function and whether both kidneys are working properly.
Female patients require a Pap smear and mammogram, as recommended by the American Cancer Society. These tests are a routine part of health care maintenance and should be arranged through your primary care doctor.
When all of the evaluation studies are completed, the results are reviewed by the medical review board. Surgery is scheduled once approved by the review board.
The following are criteria for selection of living donors:
We do not take donations from anyone under the age of 18 or anyone who is not mentally capable of making an informed decision.
Our dietician will review your health and provide guidance on healthy eating before and after donation.
It is vital for donors to have ongoing medical care to monitor the function of the remaining kidney. The United Network for Organ Sharing has recommended that all donors be required to have health insurance and a primary care doctor prior to donation, which our program strongly recommends.
All transplant programs are required to identify an independent living donor advocate (ILDA) to potential donors. This person promotes the best interest of the potential living donor, advocate for the rights of the potential living donor and assists the potential living donor in obtaining and understanding information regarding:
The benefit and need for follow-up in six months, one year and two years after donation.
The ILDA and or the donor coordinator will contact you six months, one year and two years after donation to check on your well-being and to obtain basic information about your health.
On pre-op day, the donor and recipient will have blood drawn to update lab testing. Both the donor and recipient will update their health history, review the surgical procedure and sign consents in our transplant clinic. Information will be provided regarding pre-op instructions for the evening and morning prior to surgery. A dialysis run will be required before the transplant if the recipient is on dialysis, and the transplant coordinator will make the arrangements at our UF Health dialysis unit.
If you don’t live close enough to the transplant center, there are hotels nearby where most offer a UF Health discount upon request.
After the donor returns to a room, he or she will be monitored closely by our staff. The donor will be asked to breathe deeply and cough periodically to prevent pneumonia. Donors normally are discharged two to three days after surgery. Until then, the patient will have an IV in the arm for hydration.
Clear liquids are offered usually within 24 hours after surgery, and the patient may return to a regular diet two to three days after surgery. Pain in the abdomen is normal, and pain medicine is provided to make the discomfort more tolerable. The ILDA and live donor coordinator will see the patient before discharge to discuss care after donation and plans for follow-up, including post-operative follow up and the required six-month, one-year, and two-year post-donation follow-up. They work with the team to ensure you are ready for discharge. The donor is provided information regarding care, numbers to call with problems and additional resources as needed.
A comprehensive evaluation must be conducted before determining whether you are a candidate for a kidney transplant. To facilitate that, be prepared to provide the transplant team with records of your medical history.
Once you arrive for your evaluation, you can expect a few things:
Based on our selection criteria, patients must have:
As for the aforementioned physical exam, there are a few tests you can anticipate:
Once your entire evaluation is complete, the results will be reviewed by the transplant team. You will be notified by letter when you have been accepted for transplant at UF Health and are placed on the national transplant waiting list.
Living organ donors and non-living donors are the two sources of donors. Here’s a look at the different types of donors that fall within both categories.
Transplanting a kidney from a healthy living individual into a person with kidney failure is called a living donation. Kidneys can come from living donors who may either be a living related donor (LRD), living unrelated donor (LURD) or a non-directed donor (not related to or known by the recipient). Live donor organs are usually better suited in terms of health, function and longevity in comparison to a non-living donor organ.
Non-living donors are people who have suffered brain death or cardiac death and there is consent to donate their organs. A potential transplant recipient can wait several years for a non-living kidney donor.
When a patient receives a kidney transplant, the kidney will be placed in the lower abdomen. It may be placed on either side. The donor kidney's blood vessels will be connected to the recipient’s blood vessels. The donor ureter (the tube that carries urine from the kidney to the bladder) will be connected to the recipient’s bladder. A small plastic catheter called a urinary stent will be placed across the connection to provide support. The incision will be closed with staples or sutures. The surgery takes three to four hours in most patients and an additional 90 minutes for anesthesia to prepare for the surgery after the patient is asleep.
When the recipient wakes up after the surgery, he/she will have IVs in the neck and/or arm. The IV allows for enough fluids to keep up with the large amounts of urine usually made by the new kidney. Blood may be found in urine from the surgical connection in the bladder. Medication for pain will be given to the patient for comfort.
During the first two days after surgery, the nurse will be checking blood pressure, temperature, pulse IV fluids and urine outputs. The patient will be taught to use a lung exerciser that encourage deep breathing and help open up areas in the lungs. This helps prevents pneumonia and speed up recovery. The patient will be out of bed the day after surgery and should walk as often as possible. Each morning, the patient’s blood will be drawn and they will be weighed.
The patient will be in the hospital for about five to seven days. Before the patient goes home, they will need to show our staff that they are able to:
After surgery, medicines called immunosuppressants will be administered to the recipient to keep his/her body from rejecting the new kidney. Recipients will have to take these every day for as long as they have the transplant. Even if the transplant were to fail, we recommend for the recipient to remain taking small doses of the medication to prevent antibody formation. This may help with a second transplant in the future.
There are several different immunosuppressants, and although a patient will not be taking all of these, they might be on a combination of them. Most patients go home on three of these medications.
All the immunosuppressant drugs listed above work to prevent the patient’s immune system from rejecting the transplanted organ. These medications also make it more difficult for the immune system to fight bacteria, viruses and cancer cells, which puts you at higher risk for infection and cancer. The recipient will have to take antibiotics and antivirals for the first 3-6 months after transplant to help prevent infection.
In addition to the immunosuppressants and antibiotics/antivirals, the patient may also need to take other medicines to treat high blood pressure, diabetes or other conditions. Patients may be sent home with 10 or more medications and must be committed to taking all of the assigned medicines. After a few months, many patients are on less medication after transplant than they were on dialysis.
With any procedure, there are possible complications. The following are potential risks related to the donor transplant graft, immunosuppression medications required to try to prevent rejection of the graft and possible complications if you require a blood transfusion.
It is usually not possible for transplant candidates to donate their own blood ahead of time because we never know when the transplant will occur for patients on the wait list. Anemia is a common problem with kidney disease, which prevents donation.
If you do not accept blood products due to your religion, your red blood cell count (hematocrit or hemaglobin) must be at an acceptable level at the time of transplant admission. If the level is low, the surgery may need to be cancelled. Our surgeons feel this requirement protects your safety and well-being.
The following are potential complications due to any general anesthesia (going to sleep with a breathing tube in your throat during the surgery):
The following are complications that may occur in the operating room or after surgery and related to the surgical procedure itself:
After discharge, patients have lab tests frequently to monitor kidney function, drug levels and more. A schedule of labs, clinic visits and procedures is provided.