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 preemptive kidney transplant is when you receive a kidney transplant before your kidney function deteriorates to the point of needing dialysis to replace the normal filtering function of the kidneys.

Currently, most kidney transplants are performed on people who are on dialysis because their kidneys are no longer able to adequately clean impurities from the blood.

Preemptive kidney transplant is considered the preferred treatment for end-stage kidney disease, but only about 20% of kidney transplants are performed preemptively in the U.S.

Several factors have been linked to the lower than expected rate of preemptive kidney transplants, such as:

• Shortage of donor kidneys
• Lack of access to transplant centers
• Low rates of physician referrals for the procedure among candidates of lower socioeconomic status
• Lack of physician awareness of current guidelines

Why it's done

The benefits of preemptive kidney transplant before dialysis for people with end-stage kidney disease include:

• Lower risk of rejection of the donor kidney
• Improved survival rates
• Improved quality of life
• Lower treatment costs
• Avoidance of dialysis and its related dietary restrictions and health complications

These benefits of preemptive kidney transplant are especially significant among children and adolescents with end-stage kidney disease.

Risks of preemptive kidney transplant include early exposure to the risks associated with surgery and potentially wasting native kidney function.

What you can expect

If your doctor recommends a preemptive kidney transplant, you will be referred to a transplant center for evaluation. 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.

At the transplant center, your transplant team will conduct several tests to determine if a preemptive kidney transplant is appropriate for you. Your team will consider a variety of factors, including:

• Level of kidney function
• Overall health
• Any chronic medical conditions that might affect the success of transplant
• Availability of donor kidney
• Ability to follow medical instructions and take anti-rejection medications for the rest of your life

If you are approved for a preemptive kidney transplant and a living-donor kidney is available, the living-donor kidney transplant procedure will be scheduled. If a living-donor kidney is not available, you will be placed on a waiting list for a deceased-donor kidney transplant.