Risks

Kidney transplantation can treat advanced kidney disease and kidney failure, but it is not a cure. Some forms of kidney disease may return after transplant.

The health risks associated with kidney transplant include those associated directly with the surgery itself, rejection of the donor organ and side effects of taking medications (anti-rejection or immunosuppressants) needed to prevent your body from rejecting the donated kidney.

Deciding whether kidney transplant is right for you is a personal decision that deserves careful thought and consideration of the serious risks and benefits. Talk through your decision with your friends, family and other trusted advisors.

Complications of the procedure

Kidney transplant surgery carries a risk of significant complications, including:

• Blood clots
• Bleeding
• Leaking from or blockage of the tube (ureter) that links the kidney to the bladder
• Infection
• Failure of the donated kidney
• Rejection of the donated kidney
• An infection or cancer that can be transmitted with the donated kidney
• Death, heart attack and stroke

Anti-rejection medication side effects

After a kidney transplant, you'll take medications to help prevent your body from rejecting the donor kidney. These medications can cause a variety of side effects, including:

• Acne
• Bone thinning (osteoporosis) and bone damage (osteonecrosis)
• Diabetes
• Excessive hair growth or hair loss
• High blood pressure
• High cholesterol
• Increased risk of cancer, particularly skin cancer and lymphoma
• Infection
• Puffiness (edema)
• Weight gain

How you prepare

If your doctor recommends a kidney transplant, you may be referred to a transplant center. You're also free to select a transplant center on your own or choose a center from your insurance company's list of preferred providers.

When you're considering transplant centers, you may want to:

• Learn about the number and type of transplants the center performs each year
• Ask about the transplant center's kidney transplant survival rates
• Compare transplant center statistics through the database maintained by the Scientific Registry of Transplant Recipients
• Find out if the center offers paired donation or donation chain programs that might increase your chances of receiving a living-donor kidney
• Understand the costs that will be incurred before, during and after your transplant. Costs will include tests, organ procurement, surgery, hospital stays, and transportation to and from the center for the procedure and follow-up appointments
• Consider additional services provided by the transplant center, such as coordinating support groups, assisting with travel arrangements, helping with local housing for your recovery period and offering referrals to other resources
• Assess the center's commitment to keeping up with the latest transplant technology and techniques, which indicates that the program is growing

Evaluation

After you've selected a transplant center, you'll be evaluated to determine whether you meet the center's eligibility requirements for a kidney transplant.

The team at the transplant center will assess whether you:

• Are healthy enough to have surgery and tolerate lifelong post-transplant medications
• Have any medical conditions that would interfere with transplant success
• Are willing and able to take medications as directed and follow the suggestions of the transplant team

The evaluation process may take several days and includes:

• A thorough physical exam
• Imaging scans, such as X-ray, MRI or CT scans
• Blood tests
• Psychological evaluation
• Any other necessary testing as determined by your doctor

After your evaluation, your transplant team will discuss the results with you and tell you whether you've been accepted as a kidney transplant candidate. Each transplant center has its own eligibility criteria. If you aren't accepted at one transplant center, you may apply to others.

Results

After a successful kidney transplant, your new kidney will filter your blood, and you will no longer need dialysis.

To prevent your body from rejecting your donor kidney, you'll need medications to suppress your immune system. Because these anti-rejection medications make your body more vulnerable to infection, your doctor may also prescribe antibacterial, antiviral and antifungal medications.

After transplant, skin checkups with a dermatologist to screen for skin cancer and keeping your other cancer screening up to date is strongly advised.

Kidney transplant success rates

According to the Organ Procurement and Transplantation Network:

• Failure of the transplanted kidney is reported in about 4 percent of deceased-donor kidney transplant recipients within one year after transplant and in 21 percent of cases five years after transplant.
• Among living-donor kidney transplant recipients, failure rates are about 3 percent at one year and 14 percent at five years after transplant.

Survival rates among kidney transplant recipients in U.S. transplant centers can be found online at the Scientific Registry of Transplant Recipients.

If your new kidney fails, you can resume dialysis or consider a second transplant. You may also choose to discontinue treatment. This decision depends on your current health, your ability to withstand surgery and your expectations for maintaining a certain quality of life.

Overview

A deceased-donor kidney transplant is when a kidney from someone who has recently died is removed with consent of the family or from a donor card and placed in a recipient whose kidneys have failed and no longer function properly and is in need of kidney transplantation.

The donated kidney is either stored on ice or connected to a machine that provides oxygen and nutrients until the kidney is transplanted into the recipient. The donor and recipient are often in the same geographic region as the transplant center to minimize the time the kidney is outside a human body.

Only one donated kidney is needed to sustain the body's needs. For this reason, a living person can donate a kidney, and living-donor kidney transplant is an alternative to deceased-donor kidney transplant.

Overall, about two-thirds of the approximately 20,000 kidney transplants performed each year in the U.S. are deceased-donor kidney transplants, and the remaining are living-donor kidney transplants.

The demand for deceased-donor kidneys far exceeds the supply. The waiting list has grown from nearly 58,000 in 2004 to more than 92,000 in 2017.

Why it's done

People with end-stage kidney disease need to have waste removed from their bloodstream via a machine (dialysis) or a kidney transplant to stay alive.

For most people with advanced kidney disease or kidney failure, a kidney transplant is the preferred treatment. Compared with a lifetime on dialysis, kidney transplant offers a lower risk of death, better quality of life and fewer dietary restrictions than dialysis.

The health risks associated with kidney transplant include those associated directly with the surgery itself, rejection of the donor organ and side effects of taking immunosuppressive medications needed to prevent your body from rejecting the donated kidney. These risks include higher rates of infection and some types of cancer.

What you can expect

If your doctor recommends a kidney transplant, you may be referred to a transplant center or select a transplant center on your own.

You will be evaluated by the transplant center to determine if you are accepted as a kidney transplant candidate. Each transplant center has its own eligibility criteria.

If a compatible living donor isn't available for a kidney transplant, your name will be placed on a kidney transplant waiting list to receive a kidney from a deceased donor.

Everyone waiting for a deceased-donor organ is registered on a national waiting list maintained by the Organ Procurement and Transplantation Network (OPTN). The United Network for Organ Sharing (UNOS), a private nonprofit group, administers OPTN through a contract with the U.S. government.

Additional factors used in matching deceased-donor kidneys include blood and tissue type matching and how long the candidate has spent on the waiting list. The federal government monitors the system in an effort to ensure that everyone waiting for an organ has a similar chance.

Some people get a match within several months, and others may wait several years. While on the list, you will have periodic health checkups to ensure that you are still a suitable candidate for transplantation.

When a compatible deceased-donor kidney becomes available, you will be notified by your transplant center. You must be ready to go to the center immediately for final transplant evaluation.

If the results of the final transplant evaluation are satisfactory, the kidney transplant surgery can proceed immediately.