Kidney Transplant

Kidney Transplant Process at Mayo Clinic

Kidney and pancreas transplantation involves more than surgery. Evaluation, waiting for transplant, and recovery following surgery are all part of a long journey for the transplant candidate and family. Even after full recovery, some lifestyle changes are necessary for continued health.

Issues to Consider

The goal of successful kidney transplantation is to help recipients feel better, become more active, and enjoy a better quality of life. The main benefits of a successful kidney transplant are:

• Freedom from dialysis
• Increased feeling of well-being
• Fewer restrictions on diet and activities
• Increased energy level

The following issues must also be considered when assessing the option of kidney transplantation:

• There is a risk that the transplanted kidney will never work or may be rejected by the recipient's body at any time. With rejection, the recipient would require dialysis and have to wait for another kidney transplant.
• Antirejection medications must be taken for as long as the transplanted kidney functions. These medications have many possible side effects.
• Transplant requires major surgery. Surgical complications are possible.
• Transplant may worsen medical conditions such as hypertension or bone disease.
• In some patients, the original kidney disease can return after transplant. Transplant candidates must discuss the chance of recurrence with a nephrologist.
• If a living donor is not available, the waiting period for a cadaver kidney can be lengthy.

Preparation

Each kidney-transplant candidate must be evaluated to determine whether transplantation is likely to be safe and beneficial. Pretransplant evaluation commonly includes:

• Blood tests, including tissue type analysis
• Chest X-ray
• Electrocardiogram and perhaps other heart tests
• Meeting with endocrinologists if diabetes is present
• Meeting with nephrologists specializing in kidney and pancreas transplantation
• Meeting with a transplant surgeon

Tests performed by health care facilities other than Mayo Clinic are often acceptable. Typically, two days are needed to complete this evaluation.

Transplant Surgery

During kidney transplant surgery, an incision is made in the transplant recipient's abdomen, usually on the lower right side near the "hip bone." The donor kidney is placed near the bladder on the right side of the recipient's pelvis. Surgeons usually attach the donor ureter to the recipient's bladder, allowing urine from the new kidney to flow normally. Surgeons restore blood supply to the donor kidney by connecting it to blood vessels supplying the recipient's legs.

The patient's own kidneys are usually not removed. In some cases, such as when the kidneys have been a lingering cause of high blood pressure, one or both kidneys are removed during the transplant or at a later operation.

Transplant typically takes about three hours. The recipient usually gets out of bed and takes a short walk the day after surgery. Liquids can be sipped the day of surgery, and a normal diet is usually resumed within two to three days. During recovery, most patients gradually experience less discomfort in the incision, a greater ability to move around, and return to normal activities. The donor kidney should begin to function immediately, and patients typically remain in the hospital for three to five days.

After Transplant

During visits with Mayo Clinic staff, patients have ample opportunity to discuss their situation with many experienced professionals. The following general information usually applies.

• After-hospital care
  After dismissal from the hospital, transplant recipients need to stay near Mayo Clinic for approximately three to four weeks so Mayo staff can monitor the function of the new kidney and the recipient's recovery. During that time, transplant recipients make regular visits to see the medical and surgical staff and the transplant coordinators.
  
  
• Care at home
  Mayo staff will update local health care providers about the patient's progress and Mayo's recommendations for care at home. Mayo's staff ready to provide consultation or support as necessary.
  
  Follow-up appointments at Mayo Clinic are sometimes necessary during the first year after surgery, and some patients are asked to return annually. Mayo staff is always available if problems arise.
  
  
• Long-term health issues
  Within three to six weeks after surgery, most kidney transplant recipients can resume their usual daily activities, including returning to work. Mayo's transplant nurse coordinators remain in close contact with the transplant recipient and the physician who provides regular care at home. Kidney transplant recipients must carefully follow the treatment plan developed in cooperation with their physician and the Mayo transplant team.
  
  
• Medications
  All transplant recipients need lifelong treatment with immunosuppressant medicines to prevent rejection of the transplanted kidney. These medications must be taken daily.