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Kidney transplant


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Definition

A kidney transplant is surgery to place a healthy kidney into a person with kidney failure.

Alternative Names

Renal transplant; Transplant - kidney

Description

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:

  • Living related donor -- related to the person receiving the transplant, such as a parent, sibling, or child
  • Living unrelated donor -- such as a friend or spouse
  • Deceased donor -- a person who has recently died and who has no known chronic kidney disease 

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.

Learn more about the process for donating and receiving a kidney transplant here at UF Health.


Kidney Transplant Donation

About Living Donation

Donating a kidney is a precious gift to give and requires careful consideration from donors. The most common reason for donating a kidney is a strong emotional tie with the recipient, but a donor can be a non-directed, unrelated one as well.

After deciding to donate, you will be working with a team of professionals who are dedicated to your well-being. 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.

There are many benefits that come from living donation.

  • First, the recipient has time to plan for a transplant. Research shows that the less time a patient is on dialysis, the longer a transplanted kidney will function and the longer a person will live.
  • Second, a kidney transplant doubles the life expectancy compared to staying on kidney dialysis treatment.
  • Another benefit can be the positive feelings a patient can experience knowing that the gift came from either a generous stranger or a loved one.

Donor confidentiality

Information about the donor or the recipient will not be disclosed even if the donor requests it. All interactions with the living donor team are strictly confidential, however, the donor is free to share any information with the recipient regarding the donation process. This is to protect the confidentiality of the donor and maintain the integrity of the living donor program by staying in compliance with the Health Insurance Portability and Accountability Act (HIPAA).

Sources of donor kidneys

Living organ donors and non-living donors are the two sources of donors. A patient may have to wait years for a non-living donation and non-living donors are people who have suffered brain death after bleeding in the brain or head trauma. Kidneys can also come from living donors who may either be a living related donor (LRD), living unrelated donor (LURD) or a non-directed donor.

Donation after cardiac death

Donation after cardiac death (DCD) is an option for families who have a loved one that has irreversible brain damage but still has minimal brain function. Once the family decides to withdraw care, they are offered the option of donation after cardiac death.

Matching and compatibility

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

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

  • Blood Type O
    Can donate to: A, B, AB, O
  • Blood Type A
    Can donate to: A or AB
  • Blood Type B
    Can donate to: B or AB
  • Blood Type AB
    Can donate to: AB

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 Typing

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 one in four chance in matching 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 us much less likely.

Thanks to advanced medication known as immunosuppressive or anti-rejection medications, kidney transplants can still be successful if two people don’t have matching antigens.

Cross-matching testing

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. This test can be performed up to 15 times to ensure that the result is consistent.

Paired exchange

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.

ABO incompatible

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.

Donor Medical Evaluation

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:  

History and Physical

The transplant nephrologist will go over all information on the health questionnaire and do a 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.

Psychosocial Interview

During the psychosocial interview, the donor speaks with our clinical social worker, who also serves as the independent donor advocate. This visit is a very important part of the living donor evaluation. The goals of the psychosocial interview are:

  • To evaluate the relationship between donor and recipient.
  • To assess the reason for donation and make sure the donor has not been pressured to donate.
  • To confirm there are no social or mental health issues that will affect recovery.
  • To decide if the donor needs additional education or other treatment before making the final decision.
  • To confirm the donor understands all the risks associated with living donation for both the donor and the recipient.
  • To make sure the donor is capable of making the decision to donate and cope with the stress of a major surgery.
  • To confirm the donor knows his/her evaluation is confidential and he/she may decline at any time.
  • To evaluate for high-risk behavior that may give an infectious disease to the recipient.
  • To check for history of smoking, alcohol and drug use.
  • To be sure the donor understands it is against federal law to receive anything of value in return for donating a kidney (money, gifts, etc.).
  • To discuss how donation might impact a job or family relationships.
  • To review current or past history of psychiatric disorders and treatments.
  • To review the donor’s job and insurance status and financial impact of donation.
  • To discuss the donor’s living arrangement and determine that a support system is in place and the donor has a realistic plan for recovery.
  • To explain the requirement for six, 12 and 24-month follow up appointments after donation, and to confirm the donor’s commitment to participate in the follow-up care.

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.

Education

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.

Blood tests

Multiple blood tests will be performed to assess general information about your health.

Urine tests

A urine test will be performed to check for obvious signs of kidney disease or infection. In addition, we 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.

Electrocardiogram (EKG)

An EKG evaluates whether your heart rhythm is normal and if you have any previous heart injuries.

Cardiac testing

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.

Chest X-ray

A chest X-ray is done to rule out lung disease or tumors.

Colonoscopy

If you are over age 50, you will need a colonoscopy 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.

Abdominal ultrasound

Abdominal ultrasound is completed to confirm kidney anatomy and to look for abdominal abnormalities. This is usually done just prior to a CAT-scan when you visit us. If there is an abnormality seen on the ultrasound, the radiologist will discuss this with the transplant team and this may prevent an unnecessary CAT-scan.

CT angiogram

Also known as a CAT-scan, this test evaluates the anatomy of the blood vessels going to and from the kidneys to analyze at 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 will 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.

Pap smear and mammogram

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.

Hepatitis B core antibody positive donors

UF Health allows donations from patients who have had hepatitis B in the past, but have tested negative for more serious hepatitis B surfacee antigen and viral proteins (NAT testing). These organs are only used in recipients who have antibody against hepatitis B. Testing will be done to check if the donor has hepatitis virus in the blood, which is rare. If the recipient were to test positive for the virus, the anti-viral treatment would continue for a longer period of time.

Hepatitis B antibody positive donors

Hepatitis C antibody positive donor organs are only offered to hepatitis C positive recipients. Testing is done for strains of hepatitis C virus in the blood. The majority of patients with Hepatitis C infections can be treated with medications after transplant to try to get rid of the virus. To be offered a hepatitis C positive donor organ, patients must give consent ahead of time. Donors will be sent a consent explaining the risks and the benefits. Accepting a hepatitis C positive donor organ will not decrease the possibility of receiving an organ from any other donor.

Test results

When all of the evaluation studies are completed, the results are reviewed by our living donor medical review board. Surgery is scheduled once approved by the review board.

Donor selection criteria

The following are criteria for selection of living donors:

Age

We do not take donations from anyone under the age of 18 or anyone who is not mentally capable of making an informed decision.

Smoking

  • Smoking has many health risks and can cause life-threatening respiratory issues during or immediately after anesthesia for a surgical procedure. Other risks it may cause includes developing blood clots in the leg veins, increased mucus production and a decreased ability to clear the lungs, heart and vascular diseases and decreased wound healing.
  • Candidates will not be considered for donation unless they have abstained from tobacco, including chewing tobacco, for at least four weeks prior to donation.
  • Donors are expected to remain tobacco free for six weeks after surgery and are strongly discouraged from smoking after donation as it raises the risk for kidney failure.

Drug use

  • Potential donors are assessed for use of any illicit drugs.
  • Potential donors who use chronic pain medication experience more post-operative pain after donation.
  • These individuals may be asked to see a surgeon and/or psychiatrist prior to being considered for donation. our transplant team may request random drug screening if there is concern and decline donation if the potential donor does not comply with the request.

Health Problems

  • Donors must be healthy. If a donor has a history of medical problems, or if these are discovered during the medical evaluation, he or she may be declined.
  • Our living donor coordinator will discuss the donor’s health history in detail before the evaluation begins, and the physician will review it again at the first office visit.
    • High blood pressure treated with medication (there may be special situations when the team may consider a donor over 50 years old on no more than two blood pressure medicine at low doses).
    • Diabetes. In some cases, young donors may be declined for a very strong family history of diabetes even if the donor does not currently suffer from diabetes, due to the risk of developing it later in life.
    • Gestational diabetes (diabetes during pregnancy). Donors are considered on a case-by-case basis.
    • Systemic lupus erythematosus
    • Polycystic kidney disease
    • Substance abuse
  • Psychiatric illness. If a donor has a history of mental health problems including a remote history of anxiety or other common disorders, the team may request a psychological evaluation. Donors with current mental health concerns may not be candidates for living kidney donation.
  • Heart / heart valve disease or peripheral vascular disease (disease of blood vessels in the legs)
  • Lung disease with impaired oxygenation or ventilation.
  • Recent cancer or a history of cancer that was not completely treated
  • Low kidney function shown by creatinine clearance testing
  • Protein in the urine
  • Active hepatitis B or C infection or HIV infection.
  • Required use of medicines that are known to cause kidney damage
  • History of blood clots

    Obesity

    • A candidate being overweight is a risk factor for kidney disease.
    • Candidates with a body mass index of over 32 will generally not be considered for donation unless an individual is very muscular or can lose weight to reach a BMI of 30 or less.
    • Candidates with a BMI of less than 32 may be asked to lose weight depending on weight distribution.

    Dietician

    Our dietician will review your health and provide guidance on healthy eating before and after donation.

    Psychosocial Issues

    • Our social worker will evaluate psychosocial aspects of living donation with the potential donor.
    • Donors may be declined if they have inadequate support for recovery, questionable donor-recipient relationship or motivation for donation, a history of poor coping or psychiatric illness or a history of not taking good care of their health and other similar concerns.

    Insurance coverage and primary care doctor

    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 follows.

    The independent living donor advocate

    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 consent process
    • The evaluation process
    • The surgical procedure

    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.

    The surgical experience

    Women planning to donate a kidney or to receive a living donor kidney transplant must stop taking birth control for a minimum of four weeks prior to surgery, as it has been shown to lead to an increased risk of blood clots.

    Pre-op day

    On pre-op day, the donor and recipient will have blood drawn for the final cross-match and for updated 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. Recipients should make sure to avoid foods containing potassium several days prior to surgery. A high potassium intake before surgery may result in urgent dialysis the morning of surgery or cancellation of surgery on the day of. High potassium can lead to heart arrhythmias during or after surgery. If you are on peritoneal dialysis, please bring your dialysis equipment so you may perform your dialysis the night before surgery and then empty the morning of surgery.

    If you don’t live close enough to the transplant center, there are hotels nearby where most offer a UF Health discount upon request. Reservations must be made directly by calling the hotel rather than online.

    Surgery day

    • The morning of the surgery, the donor and recipient will arrive at the pre-surgery admissions area in the UF Health Shands Cancer Hospital on the south side of Archer Road. Maps and instructions will be provided ahead of time.
    • The surgical procedure will take about four ½ hours, including a 60-90 minute period in the operating room before and after surgery for the patient to be placed under general anesthesia and to wake up after the surgery.
    • The donor surgery is completed using the laparoscopic technique because it has a quicker recovery time. During surgery, an incision is made about three inches long to remove one kidney with its artery, vein and the ureter.
    • Families wait on the 2nd floor surgical waiting area in UF Health Shands Cancer Hospital. After surgery, the surgeon will let the family know how the procedure went and the family may visit the patient once he or she returns to a room.

    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 accumulation of water in the lungs. Water in the lungs may lead to a risk of infection. Patients will be 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 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.


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    Receiving a Kidney Transplant

    What to expect after surgery

    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. If a clot were to form and block the catheter tube, the nurse will need to flush it. 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 will measure how deeply the patient is breathing and will 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 seven to 10 days. Before the patient goes home, they will need to show our staff that they are able to:

    • Learn to take your medicines correctly
    • Make changes in your medication record accurately
    • Monitor fluid intake and urine output
    • Weigh yourself
    • State signs and symptoms of rejection and infection
    • Pass a basic transplant test
    • Know how to call your transplant nurse coordinator for any questions or problems

    The UF Health Shands Transplant Center is open from 8 a.m. to 4:30 p.m. Monday through Friday. If an urgent problem occurs, your transplant coordinator is available outside of business hours. After the first six months following your transplant, you should consider calling your primary care doctor or local nephrologist with any medical problems. The transplant nephrologists and surgeons are available 24 hours a day to consult with any physician caring for you. These physicians can be contacted through
    the hospital operator at 352.265.0111.

    Medications

    After surgery the recipient will be receiving medicines called immunosupressants to keep their 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.

    • PROGRAF (TACROLIMUS) – is taken twice a day. The side effects of this drug include headache, hand tremors, nausea, diarrhea, high blood pressure, increased blood sugar, increased potassium and decreased magnesium. Tacrolimus can also harm your kidneys over time, especially if the levels are too high. The dosing of this drug is based on the amount of drug in your blood. You must take care to dose it 12 hours apart and have your blood tests done just before your morning dose. This type of drug is called a calcineurin inhibitor. (do you want to add the extended release tacrolimus drugs here and just say it is the same tacrolimus mediation, but in a special capsule so it is released more slowly throughout a full day, so it is taken once a day. Envarsus and Advagraf)
    • CYCLOSPORINE (NEORAL, GENGRAF) – is taken twice a day. The side effects of this drug include high blood pressure, mild hand tremors, headache and increased growth of hair. Cyclosporine can also harm your kidneys over time. You must take care to dose it 12 hours apart and have your blood tests done just before your morning dose. Cyclosporine is closely related to tacrolimus, so you will not take both of these medications at the same time.
    • RAPAMUNE (SIROLIMUS) – is taken once a day in the morning. The side effects of this drug are ankle swelling, abdominal pain, nausea, diarrhea or constipation, joint aches, fever, headache, high blood pressure, anemia and high cholesterol and triglyceride levels. Blood levels are also measured for this medicine so blood test should be done before your morning dose. This type of drug is called a mTOR inhibitor.
    • EVEROLIMUS (CERTICAN) – is taken two times a day. It is related to Rapamune in how it works and its side effects.
    • CELLCEPT (MYCOPHENOLATE MOFETIL) – is taken two times a day. The side effects of this drug are diarrhea, nausea, vomiting, rash and low white blood cell count with increased risk for infection.
    • MYFORTIC (MYCOPHENOLATE SODIUM) – is taken twice a day and is very similar to Cellcept.
    • PREDNISONE – is a steroid and is often taken for the life of the transplant and is taken once a day. Some patients will suffer from difficulty sleeping or may feel “hyper” when taking larger doses early after the transplant. These feelings will pass in a few days and will decreasing the amount you take. The major side effects of long-term prednisone are increased appetite, stomach ulcers, osteoporosis, diabetes, cataracts, mood swings and Cushing’s syndrome. Cushing’s syndrome includes round cheeks, protruding abdomen, fat deposits over the upper back, acne, and increased growth of facial and body hair. Most patients are not on high enough doses to suffer from these side effects, and these side effects will decrease or disappear as the dose is decreased. After a few weeks, you are only taking about twice as much prednisone as your body makes naturally.

    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 three to six months after transplant to help prevent infection and also have regular physicals with a primary care doctor for cancer screening, including screening for skin cancer, which is the most common post-transplant cancer.

    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 up to 12 medications after their surgery and must be committed to taking all of the assigned medicines. After a few months, most patients are on less medication after transplant than they were on dialysis.

    Potential risks

    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.

    • Risk of rejection of the transplanted organ (this is not related to the surgery itself but with your immune system attacking the kidney)
    • Increased risk of infection due to the immunosuppressant medications
    • Any of the side effects of the immunosuppressant medications as previously discussed.
    • Very small risk for acquiring HIV/AIDS, Hepatitis B, Hepatitis C, other viruses or a cancer from the donor organ. Non-living organ donors are screened very carefully for these diseases by the organ procurement organizations, however, on rare occasion, the infections or cancers are not detectable and may be passed to the recipient.
    • Potential for a blood transfusion due to blood loss in the operating room and related risk for the transmission of infectious diseases from a blood donor. Blood donors are screened very carefully, but there may be a rare case when a disease may be undetectable and may be passed to the recipient. Few transplant recipients require a blood transfusion if they come into the operation with a good blood count, that is, that they do not have anemia.

    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.

    Note: If you do not accept blood products due to your religion, your red blood cell count (hematocrit) must be greater than 36 at the time of transplant admission. Our surgeons feel that 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):

    • Chipped teeth, a sore throat or an injured vocal cord from the insertion of the breathing tube
    • Allergic reaction to medications used to put you to sleep
    • Risk of infection from the insertion of IV lines
    • Risk of a pneumothorax (collapse of the lung) from the insertion of a large IV line (used for giving fluids) that may require a tube placed next to your lung to allow this to heal
    • The possibility of requiring mechanical ventilation (a breathing machine or respirator) after surgery
    • Risk of death due to problems with the heart (such as heart attack or abnormal heart beats) or lungs (especially from a blood clot traveling to your lungs during or after surgery)

    The following are complications that may occur in the operating room or after surgery and related to the surgical procedure itself:

    • Wound infection and/or hernia that could require another surgery to repair the hernia or clean the infection.
    • All surgical wounds have pain afterwards, which usually resolves over a couple of weeks. Occasionally, a local nerve may heal abnormally and give you persistent pain. These nerves can sometimes be injected directly by pain specialists several weeks after you recover from the transplant procedure. All surgical incisions have some numbness around them from cutting the skin nerves.
    • All surgeries will have some bleeding. Occasionally, you could require a blood transfusion as you will fill up the new kidney graft with your blood, and you will bleed some. Most patients therefore have a blood count decrease equivalent to donating one unit of blood and do not require a blood transfusion unless they have a low red blood cell count before surgery, or if they are on a blood thinner (such as coumadin, Plavix or others), or if they have significant hardening of the arteries and have a difficult blood vessel connection. You can also require return to the operating room to wash out blood clots and/or check for ongoing bleeding, especially when you have been on blood thinners or have diseased blood vessels.
    • Rarely, you can have a significant blood vessel problem during or after surgery. This is most commonly due to severe hardening of the arteries (atherosclerosis). In surgery, the surgeons need to clamp your blood vessels to temporarily stop the blood flow to the leg. Very diseased blood vessels may not open up normally and may not allow blood to flow normally after removing the clamps. This may rarely result in not enough blood flow to your leg and urgent surgery to restore blood flow to your leg. This is very uncommon and occurs less than once a year at large transplant centers. This may also result in loss of the kidney graft due to clotting.
    • The kidney graft may clot and be lost. This is uncommon overall, less than 5 out of 100 surgeries, but can happen more often when you have blood vessel disease, or when the kidney has more than one artery or a vein injury from the donor operation. When a kidney has more than one artery, the multiple arteries are smaller in size and more difficult to connect to your artery. Rarely, the vein allowing blood to leave the kidney may clot also. This is most often due to an anatomy issue from the donor.
    • For most patients, we make the incision from just above the bladder to just inside the hip in the lower abdomen, and we are usually able to stay around the outside of the intestines (outside the peritoneal membrane), and therefore have little to no chance of direct bowel injury. For some patients, we may need to enter into the middle of the abdomen and have a greater chance of injuring the bowel. This is especially true in patients who have previous transplants or prior blood vessel surgery.
    • Some patients may have pain or numbness on the thigh below the incision from irritation of a nerve that runs close to the blood vessels used to connect the kidney. This usually improves over several weeks.
    • If the kidney fails early, it may be removed with another surgery if your transplant physicians feel this is necessary, usually due to bleeding, infection or pain.
    • A kidney graft may not work at all after surgery. This occurs less than 5 out of 100 times, but it does happen to about four to five out of 100 patients in the United States. Most kidneys do work within a day or two after surgery, and more than 80 of 100 patients will leave the hospital in a week or less with the kidney working well enough to not require dialysis. Of the less than 20 of 100 patients leaving the hospital requiring dialysis, about 15 of these 20 patients will have the kidney wake up and work enough to get them off dialysis. The national OPTN/UNOS kidney allocation system will allow the four or five of 100 patients who do not have kidney function to get back in line on the waiting list where they were before this kidney transplant. That is, they will get their waiting time back. (If you lose your kidney graft due to rejection after the kidney was originally working, you may not get your waiting time back).

    Potential complications with new kidney

    • Delayed Graft Function – Typically the transplanted kidney will make urine right away. In some cases, the kidney may have a delayed function after surgery. This is called a Delayed Graft Function (DGF) and usually results from acute tubular necrosis (ATN). DGF can occur as a result of factors related to the donor such as low blood pressure before donation. DGF may also occur if the recipient has a low blood pressure and/or unexpected bleeding during surgery or a biopsy.Sometimes the patient may have to just wait patiently for the new kidney to start working and may require dialysis for a few weeks or months. DGF is suspected when the creatinine does not fall quickly after transplant. The creatinine may decrease slightly each day, but if it remains high, there is no way to tell for sure whether rejection is also happening. If this happens, a biopsy is usually done so that the doctors can treat any rejection quickly.
    • Primary Non-Function – Primary non-function is when the transplanted kidney never starts to work. This can happen, but is rare. If this were to happen, dialysis is usually required in the first 48 hours after surgery and will continue to be required on a regular basis. Patients with primary non-function usually have a renal biopsy that reveals irreversible damage. In some cases the transplanted kidney needs to be surgically removed. Primary non-function does not prevent you from having another transplant, and the Transplant Center can request reinstatement of your original wait time allowing re-transplant to happen sooner.
    • Infection – Infection is a constant risk to transplant recipients. The immunosuppressive medications that you take to prevent rejection cause you to be at increased risk for infections. You will take antibiotics to prevent infection for the first three to six months after your transplant.
    • Dehydration – Dialysis patients are trained to avoid extra fluid. When you have a functioning kidney, restricting fluid can lead to dehydration. During summer months it is especially important to drink plenty of fluids because the water loss from heat/perspiration can cause dehydration and your creatinine to rise. Most adults with good kidney function will be encouraged to drink at least 3 to 3 ½ quarts (or liters) per day.
    • Urine Leak – The ureter is a muscle tube that drains urine from your transplanted kidney to the bladder. An incision is made in the bladder so the ureter can be stitched to the bladder. If the bladder becomes too full before the incision in the bladder has healed, then the ureter can pull away from the bladder and urine can leak out. If a urine leak occurs, the urine draining from your catheter will stop. Usually this occurs abruptly. As the urine drains into the area around the kidney, you may develop pain. The only treatment for this problem is an operation to reconnect the ureter.One of the reasons that you will have a catheter is to keep the bladder from becoming too full. Once your catheter is removed, it is important for you to go to the bathroom frequently during the first few days to prevent the bladder from becoming very full. Most patients will feel the urge to go to the bathroom frequently because the bladder shrinks over time when your kidneys do not make urine. When the transplanted kidney produces large amounts of urine, you may feel like going to the bathroom often. After you leave the hospital, the end of the muscular ureter can scar down and close off blocking urine from leaving the kidney by what we call a stricture. If this narrowed area is very short in length, it can sometimes be stretched by a balloon placed across it by the radiologists going through the kidney. If the stricture is long or does not stretch with the balloon, it could require a surgery to correct it.
    • Donation after Cardiac Death – There will be some degree of oxygen deprivation from organs recovered from a donor after cardiac death and as a result, the kidneys may be slow to start and may have an increased risk of delayed graft function.
    • BK Virus – Most people get BK virus, or polyomavirus, in early childhood and see no symptoms. The virus stays present in the kidneys and can be detected by a kidney biopsy. Most illnesses caused by BK virus occur in those receiving immunosuppression after an organ transplant. Kidney injury develops late in the course of BK virus disease and reducing the amount of immunosuppressive medication can help decrease the virus.

    Follow-up

    After discharge, patients have lab tests every Monday and Thursday. On lab days, do not take Prograf, Cyclosporine or Rapamune before having blood drawn. The blood tests will be drawn right before your morning dose so we can measure the lowest level of these drugs in your blood. All other medication can be taken at your normal time.

    • Patients will visit our transplant clinic two times a week for the first month after surgery. During your first clinic visit after discharge, plan to be at the appointment for a couple of hours. Make sure to bring all of your medicines and your transplant diary.
    • Your lab tests and clinic visits arrangements will be made by one of the transplant coordinators when you are discharged. As time passes, the clinic visits and lab tests will be less frequent.
    • If you don’t live in the Gainesville area, we can make arrangements with a lab closer to you for blood tests. It’s important for you to be seen regularly by a transplant doctor the first couple of months after your transplant.
    • Patients should not drive for about three to four weeks after their transplant. All transplant patients need to have a primary care doctor and they must pay close attention to routine health maintenance.
    • A ureteral stent is placed during surgery and will stay in place for four to six weeks. It is a small, soft tube about six inches long that is placed in the ureter. The purpose of this is to hold the ureter open and maintain proper drainage of urine until the surgical connection between the transplanted ureter and the bladder heals. Your stent removal appointment will be scheduled prior to discharge and takes place at the UF Health urology clinic as an outpatient visit.
    • A biopsy of the transplanted kidney is ordered three to 12 months after transplant. A biopsy of the kidney tells our staff what is happening at the microscopic level of your kidney and it involves taking one or more tiny samples of you kidney to look at with microscopes. A biopsy can identify early scarring from chronic rejection, injury from medications or the silent rejection that can occur as creatinine goes up. This is performed with a needle that is placed through the skin and removes tiny pieces of kidney guided by ultrasound pictures. The procedure is done under local anesthesia and takes about half an hour. After the procedure, the patient rests for a few hours and is then able to return home. The patient will be contacted with the results one to two weeks after the biopsy.

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