What is Kidney Transplantation

Kidney Transplantation is surgery to replace one of your kidneys with a kidney from another person (donor kidney). You may need a kidney transplant if no other treatment can restore health to the kidneys.

Kidney Transplantation is a major surgery. You will work with a team of health care providers (transplant team) to help you prepare for the procedure and help you recover.

A donor kidney may come from a living person, or it may come from someone who has died and donated his or her kidney. You may be put on a waiting list for the donation and may get treatment with an artificial kidney (dialysis) during this time.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any medical conditions you have.
• Any surgeries you have had.
• Any blood disorders you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

This is a major surgery. Problems may occur, such as:

• High blood pressure.
• Infection.
• Bleeding.
• Your disease-fighting system (immune system) attacking the new kidney. This is called rejection.
• Blood clots in the blood vessels of the new kidney.
• Narrowing of the blood vessels of the new kidney.
• Fluid buildup around the new kidney.
• Urine blockage or leaking where the new kidney attaches to the bladder.
• Damage to other structures or organs.
• Emotional problems and stress caused by the long recovery and the need to limit contact with other people after the procedure.
• Problems caused by medicines, such as allergic reaction or a higher risk of:
  • Infections.
  • Diabetes.
  • Certain types of cancer.
  • Bone thinning (osteoporosis).

What happens before the procedure?

Medicines

Ask your health care provider about:

• Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
• Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
• Taking over-the-counter medicines, vitamins, herbs, and supplements.

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

General instructions

• You will have many tests, including blood tests and imaging tests.
• Ask your health care provider how your surgical site will be marked or identified.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. These can affect how medicines work and may slow the healing process. If you need help quitting, ask your health care provider.
• You may need to plan for a long recovery time with limited activity. You may need psychological and emotional counseling to prepare for the procedure and the long recovery.

What happens during the procedure?

• To lower your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Hair may be removed from the surgical area.
  • Your skin will be washed with soap.
• An IV will be inserted into one of your veins.
• You will be given a medicine to make you fall asleep (general anesthetic). You may also be given a medicine to help you relax (sedative).
• A catheter will be inserted into your bladder to drain urine during and after surgery (urinary catheter).
• An incision will be made in your lower abdomen.
• The donor kidney will be placed in your abdomen.
• The blood vessels of the new kidney will be sewn onto blood vessels inside the abdomen.
• The part of the body that drains urine from the new kidney to the bladder (ureter) will be sewn into the bladder.
• Usually, your old kidneys will be left in their normal position. The old kidneys may be removed if they are enlarged due to cysts or if they cause problems such as high blood pressure or infections.
• A tube may be placed near the new kidney to drain excess fluids from the surgical area (surgical drain).
• Your incision will be closed with stitches (sutures) or staples and covered with a bandage (dressing).

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• You may breathe through a tube in your throat. While this breathing tube is in place, you will be given medicine that keeps you asleep (sedated). If there are no early signs of bleeding or rejection, the breathing tube will be removed.
• You may continue to have:
  • An IV providing nutrition and fluids. This may be removed after a few days, when you can start eating a normal diet.
  • A urinary catheter.
  • Surgical drains.
• You will be given medicines that:
  • Help to relieve pain.
  • Help to prevent rejection of the new kidney.

Summary

• Kidney transplant is a major surgery. A transplant team will help you prepare for the procedure and help you recover.
• This procedure is done with general anesthesia. This means that you will be asleep during the procedure. You may continue to be asleep (sedated) for a period of time after the procedure.
• A risk of this procedure is that your body may reject the kidney from another person (donor kidney). You will be monitored closely for symptoms of rejection.

Kidney Transplantation Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Soreness in your abdomen.
• Fatigue.
• A weak disease-fighting system (immune system).
• Changes in mood.

Follow these instructions at home:

Work closely with your team of health care providers (transplant team). Learn as much as you can about your condition so that you have an active role in your treatment and recovery.

Watching for rejection

Rejection means that the immune system is attacking the new kidney. This is most common in the first few months after surgery. If you have changes in certain body measurements or have certain signs or symptoms, you may be having a rejection response.

• Take the following measurements every day. Ask your health care provider how to measure your:
  • Temperature.
  • Blood pressure.
  • Fluid intake.
  • Urine output.
• Watch for any of the following signs or symptoms of possible rejection:
  • Fever.
  • Muscle aches.
  • Abdominal or side pain.
  • Decreased urine output.
  • Sudden weight gain.

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider. These include pain medicines.
• Ask your health care provider what side effects you should be aware of.
• Develop a routine to make sure you take all your medicines correctly and at the right time each day.

Eating and drinking

• Work with a nutrition specialist to make sure that you eat enough calories and healthy foods, including proteins and minerals.  
• Follow instructions from your health care provider about:
  • Taking supplements or vitamins.
  • Diet restrictions. You may need to limit salt.
• Drink enough fluid to keep your urine pale yellow.
• Do not eat raw or undercooked foods. Those foods raise your risk of infection. Make sure that all the food you eat is cooked completely or safe to eat.

Bathing

• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you may take showers. You may only be allowed to take sponge baths.

Incision care

• Follow instructions from your health care provider about how to take care of your incision. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision area every day for signs of infection. Check for:
  • Redness, swelling, or pain.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Activity

• Ask your health care provider what activities are safe and what activities you should avoid. You may be able to return to normal activities gradually over several weeks.
• Do not do any of the following until your health care provider approves:
  • Lift anything that is heavier than 10 lb (4.5 kg), or the limit that your health care provider tells you.
  • Travel far from the hospital, clinic, or transplant center.
  • Drive or use heavy machinery, if applicable.

Lifestyle

• Do not use any tobacco products, such as cigarettes, chewing tobacco, and e-cigarettes. If you need help quitting, ask your health care provider.
• Do not use alcohol.

Preventing infection

• Certain medicines that you take may raise your risk of infection. Make sure that you:
  • Wash your hands frequently with soap and water. If soap and water are not available, use hand sanitizer. Have close friends and family members also wash their hands often with soap and warm water.
  • Avoid close contact with people who are sick.
• Ask your health care provider when it is safe for you to get vaccines, and ask which vaccines are safe for you.

Sun protection

• Protect yourself from the sun by:
  • Wearing sunscreen (with an SPF 30 or higher).
  • Avoiding outdoor activities when the sun is strongest (between 10 a.m. and 4 p.m.).
  • Wearing a wide-brimmed hat and sunglasses.

General instructions

• Wear compression stockings as told by your health care provider. These stockings help to prevent blood clots and reduce swelling in your legs.
• Talk with your health care provider if you are having any emotional problems during your recovery, such as sadness, stress, or anxiety.
• Keep all follow-up visits as told by your health care provider. This is important. You will need to return to your hospital, clinic, or transplant center often to have:
  • Blood tests.
  • Kidney function tests.
  • Kidney imaging tests.

Contact a health care provider if:

• You have signs of infection at the incision site.
• You have side effects from medicines.
• You have chills or a fever.
• You have any changes in your:
  • Temperature.
  • Blood pressure.
  • Urine output.
• You have sudden weight gain.
• You have any symptoms of an infection, such as:
  • Cough.
  • Nasal stuffiness (congestion).
  • Sore throat.
  • Diarrhea.
  • Sores on the skin or in the mouth.
  • Burning pain while urinating.

Get help right away if:

• You have a sudden decrease in urine production.
• You have any signs or symptoms of possible rejection.
• You have difficulty breathing.
• You become very tired or sleepy.

Summary

• Work closely with your team of health care providers (transplant team) during your recovery. It is important for you to have an active role in your recovery and treatment.
• Stay close to your hospital, clinic, or transplant center. You will need to return often to have follow-up tests.
• Make sure that you know when to call your health care provider and when to call emergency services.