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Kidney Transplantation: Preparing for and Managing Life After Transplant

Jul 13, 2023

More than 50,000 people in the U.S. live with end-stage renal disease (ESRD). ESRD, or kidney failure, is the last stage of chronic kidney disease (CKD). ESRD cannot be reversed and is generally treated with long-term dialysis or a kidney transplant.

Key Points 

  • A kidney transplant is typically performed to treat kidney failure, as long-term dialysis increases patients’ risk of developing adverse risk factors.
  • Recovery from kidney transplant surgery can be different for every person.
  • Innovative kidney transplant technology is on the rise to address the growing gap between ESRD patients who need a transplant and the shortage of donors.

Kidney Transplantation Overview 

A kidney transplant is a surgery done to replace a kidney that has completely failed with a healthy kidney from a donor. There are two sources of kidney donations: a deceased donor and a living donor. Living donor transplantations have a marginally higher success rate compared to deceased donor transplants.

Potential kidney donors are thoroughly screened to ensure they are a match to help prevent complications such as rejection.

A kidney transplant is needed for people that have ESRD, which is treated with dialysis or a transplant. Some conditions of the kidneys that may develop into ESRD:

What are kidney transplant requirements? 

Kidney transplant requirements differ between transplant centers but in general, kidney transplant candidates should have the following:

  • ESRD and be on dialysis
  • A life expectancy of at least five years
  • Late-stage CKD, approaching the need for dialysis
  • A comprehensive understanding of postoperative care and instructions

Who is ineligible for a kidney transplant?

Kidney transplants are evaluated and approved on a case-by-case basis, with each transplant center setting its own guidelines. However, some factors could make someone ineligible for a kidney transplant:

  • Alcohol or drug abuse
  • A serious health condition (current or recent cancer diagnosis)
  • Recurring infection
  • A short life expectancy
  • Serious heart disease
  • Not being healthy enough to survive surgery

Pre-Kidney Transplant 

Before surgery is scheduled, you will undergo an evaluation by a transplant center to determine if you are ready for a kidney transplant.

The transplant procedure will be scheduled if you are receiving a kidney from a living donor, such as a family member. If you are on the waiting list for a deceased donor kidney, the transplant center will inform you when a suitable (matched) kidney is available. The transplant team will perform final checks (blood tests) to help ensure that there are no complications and that the surgery can proceed.

What happens during a kidney transplant procedure?

During the transplant surgery, once you have been given anesthesia and are asleep, the surgeon will make an incision on your abdomen. The new kidney will be placed in this area (belly area), with the donor’s ureter sewn to your bladder. Generally, your kidneys that have failed will not be removed.

The surgeon will then close the incision, and you will be moved to the recovery room to wake up. Usually, kidney transplant procedures take two to four hours.

Kidney Transplant Recovery 

Post-kidney transplant surgery recovery can differ for every person, but you will typically spend 3-7 days in the hospital before discharge. While in the hospital, your transplant and care team will closely monitor your recovery. The new kidney may start working (producing urine) immediately or may take a few days. Dialysis is used in the interim until the transplanted kidney starts producing urine.

Immunosuppressants or anti-rejection medicines are prescribed to prevent the body from rejecting the new kidney. Immunosuppressants work to suppress (lower) the immune system to reduce its response to fight the new kidney.

Once your transplant team is satisfied with your recovery status, you will be released from the hospital to continue recovering at home.

Follow-ups and lab work are critical to post-transplant treatment and will be scheduled with your doctor. These visits will be more frequent during the first month you leave the hospital, decreasing over time. Talk to your transplant center about programs and resources to help with follow-up appointments.

Most people will recover within three months, but before returning to work or normal activities, be sure to check with your healthcare provider.

At-home recovery

Your transplant team will provide you with information on how to care for yourself and your new kidney at home.

Some general guidelines during at-home recovery include:

  • Activity. Try walking for 15-20 minutes every day, slowly adding more time. Strenuous exercise and lifting weights can resume when your transplant team advises you can.
  • Diet. You should eat a heart-healthy diet and drink plenty of fluids. A dietician will help you plan the correct meals for your requirements.
  • Incision care. Keep the incision area dry and clean.
  • Medicines. Take your medicine as prescribed. They are vital for ensuring a healthy transplant and reducing the risk of rejection. It is suggested to limit contact with people who are sick as immunosuppressant medicines weaken the immune system.
  •  Mental Health. Some mental health challenges may present during the stages of receiving and recovering from a kidney transplant. Ensuring that you have an emotional support team to help navigate conflicting feelings can help. Your transplant team will also be able to provide you with resources for support groups.

When to call your doctor 

While you will see your doctor regularly for check-ups, if you experience any of the following symptoms, immediately contact your healthcare provider:

  • New pain or tenderness around the new kidney
  • A fever of 100℉ or higher
  • Edema (swelling)
  • Headaches, chills, dizziness, vomiting, and nausea
  • A noticeable difference in the amount of urine you produce

Follow your doctor and transplant team care instructions closely to ensure the best possible outcome.

How long does a kidney transplant last?

Typically, a kidney transplant can last for 10-20 years. Kidney transplants from a living donor are estimated to last 15-20 years, while a kidney transplant from a deceased donor averages 10-15 years. Ultimately how long a kidney transplant lasts depends on how well it is cared for, among other factors.

Kidney rejection after transplant 

Kidney rejections occur due to the body’s response to the transplanted kidney’s foreign proteins, with the immune system “protecting” your body from the protein. The main reasons why a kidney transplant may fail include:

  • Not taking immunosuppressant medications as prescribed
  • Infection
  • Long-term side effects of medicines
  • Rejection

Two types of kidney rejection can occur after transplantation:

  • Chronic rejection. This occurs slowly for years after a transplant due to a continuous immune response to the new kidney. Chronic rejection typically occurs more often than acute rejection.
  • Acute rejection. This generally occurs in the first three months after a transplant. 20-30 people out of 100 will experience an acute rejection episode. Less than 5 five people who experience an acute rejection episode will lead to failure of the new kidney.

The risk of kidney rejection differs from person to person but occurs less frequently than it used to due to advances in immunosuppressive therapy. For this reason, it is recommended to take immunosuppressant medications exactly as prescribed by your doctor after a kidney transplant.

New Kidney Transplant Technology

The newest innovations in renal replacement technology are cellular kidney regeneration and implantable bioartificial kidney (BAK). Renal replacement technology aims to create a fully functioning alternative to dialysis or a donor organ.

Kidney transplant technology may address the associated risks of kidney transplants and dialysis, such as the risk of renal cancer, infections, and the effects of immunosuppression.

Panoramic Health 

Panoramic Health is a physician-led value-based kidney care platform that delivers better patient outcomes at a lower cost for patients, providers, and payer. Our platform uses the largest, real-time CKD patient database, enabling analytics and risk stratification. This robust database powers our data-driven care interventions for patients at the right time.

We leverage analytics and data to individualize treatments based on each patient’s risk profile and stage, enabling us to proactively expedite transplant evaluation or access placement.