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 living-donor kidney transplant is when a kidney from a living donor is removed and placed into a recipient whose kidneys no longer function properly.

Only one donated kidney is needed to replace two failed kidneys, which makes living-donor kidney transplant an alternative to deceased-donor kidney transplant.

About one-third of all kidney transplants performed in the U.S. are living-donor kidney transplants. The other two-thirds involve a kidney from a deceased donor.

Why it's done

Compared with deceased-donor kidney transplant, the benefits of living-donor kidney transplant include:

• Less time spent on a waiting list, which could prevent possible complications and deterioration of health of the recipient
• Potential avoidance of dialysis if it has not been initiated
• Better short- and long-term survival rates
• Your transplant may be scheduled in advance once your donor is approved versus an unscheduled, emergency transplant procedure with a deceased donor kidney

The risks of living-donor kidney transplant are similar to those of deceased-donor kidney transplant. They include risks associated with the surgery, organ rejection and side effects of anti-rejection medications.

What you can expect

Living-donor kidney transplant usually involves a donated kidney from someone you know, such as a family member, friend or co-worker. Genetically related family members are most likely to be compatible living kidney donors.

A living kidney donor may also be someone you don't know, a non-directed living kidney donor.

Both you and your living kidney donor will be evaluated to determine if the donor's organ is a good match for you. In general, your blood and tissue types need to be compatible with the donor.

However, even if your donor isn't a match, in some cases a successful transplant may still be possible with additional medical treatment before and after transplant to desensitize your immune system and reduce the risk of rejection.

If your living kidney donor isn't compatible with you, your transplant center may offer you and your donor the chance to participate in the paired donation program. In paired living-organ donation, your donor gives a kidney to someone else who is compatible. Then you receive a compatible kidney from that recipient's donor.

Once you've been matched with a living kidney donor, the kidney transplant procedure will be scheduled in advance. The kidney donation surgery (donor nephrectomy), and your transplant typically occur on the same day.