Kidney transplant

What is a kidney transplant?

A kidney transplant is an operation to transfer a healthy kidney from one person (either a living donor with two healthy kidneys or a person who has recently died) to another person who has little or no kidney function. For more information about the kidneys, see also What do kidneys do? and the separate leaflet called Chronic kidney disease.

Although dialysis can be used to make up for the loss of kidney function, this is inconvenient and time-consuming and has worse medical outcomes than a kidney transplant. Therefore, a kidney transplant is the treatment of choice for most people for kidney failure.

Who can have a kidney transplant?

In order to have a kidney transplant:

• You need to be well enough to have the operation. This means that someone who is very frail or who has other medical conditions, such as heart failure, which might result in problems during the operation, might be advised not to have a transplant.

• The transplant should have a good chance of success. This means that the person donating the kidney (the "donor") needs to be a good "match" to you, the "recipient" (this includes such things as blood type and tissue type).

• You are able to take the recommended treatments after the transplant, including immunosuppressant medicines (see below).

Some people are unable to have a kidney transplant. The reasons for this include severe heart disease or having cancer that has spread or is not easily treatable.

Waiting for a kidney transplant

Most people with kidney failure need dialysis while they wait for a donated kidney to become available. The time a person spends on the waiting list for a kidney transplant is variable but in the UK the average is about three years. The waiting list is not a strict queuing system as available kidneys need to be matched to the most suitable recipient.

If you're on the waiting list for a kidney transplant, the transplant centre will need to contact you at very short notice once a kidney becomes available. Therefore, you must inform the centre if there are any changes to your contact details or medical condition. If you go on holiday, you need to let the transplant team know and they will temporarily suspend you from the waiting list whilst you are away.

Make sure you always have an overnight bag ready for when the call comes, and make arrangements so you can go to the transplant centre as soon as a donor kidney becomes available.

While waiting for a donated kidney to become available, it's important to stay as healthy as possible by:

• Eating a healthy diet.

• Losing weight if obese. There are lots of studies showing that people with a body mass index of greater than 30 have more complications after a kidney transplant. Most centres will allow someone with a body mass index of up to 35 on their waiting lists but becoming a healthy weight prior to a kidney transplant will increase the chances of successful surgery.

• Taking regular exercise if possible.

• Cutting down on alcohol.

• Stopping smoking. Although most centres will consider smokers for a kidney transplant, the risks of the transplant failing or causing complications are higher so, if you are still smoking whilst waiting for a kidney transplant, you may be lower on the priority list.

The transplant procedure

If you receive a kidney from a living donor, this will be a carefully planned operation. If you're waiting for a deceased donor kidney, the transplant centre will contact you when a suitable kidney becomes available. Some final checks will be performed to be sure the transplant should go ahead. Sometimes, when a kidney becomes available, those last-minute checks show that the transplant would not be safe and so it does not go ahead, even at the last minute.

The new kidney will be placed in the lower part of your tummy (abdomen). Your own kidneys will usually be left in place.

Because of the risk of further problems, people who have had a kidney transplant require regular check-ups for the rest of their lives. This will be at the "nephrology" department of the hospital. Nephrologists are kidney specialists.

Living with a kidney transplant

Having a healthy lifestyle after a kidney transplant goes a long way to minimise the risk of complications. Therefore, it's recommended that you:

• Eat a healthy diet.

• Lose weight if you're overweight.

• Take regular exercise if possible.

• Cut down on alcohol.

• Stop smoking.

You will need to take medicines that stop your body attacking and rejecting the transplanted kidney (immunosuppressants) after the kidney transplant. A combination of two or three different immunosuppressants is usually taken long-term.

There are some people who, even with immunosuppressants, are very sensitive to even small differences in tissue type and who would be more likely to have a transplant rejection. The National Institute for Health and Care Excellence (NICE) has recommended the use of a drug called imlifidase for this small group of people which can be taken before their kidney transplant. This has been shown to reduce the risk of a rejection.

Immunosuppressant medicines reduce your body's ability to fight infections, particularly in the first 6 months. Therefore, you should avoid close contact with people who have infections.

Kidney transplant risks

Although the risk of any serious complications has become much lower over the last few years, complications can still occur. Most complications occur in the first few months after a transplant, but may develop after many years.

Short-term complications

• Infection:

  • Minor infections, such as urinary tract infections (UTIs), colds and flu, are common after kidney transplants.

  • Potentially more serious infections, such as pneumonia and cytomegalovirus (CMV), can also occur but less often.

  • You may be given antibiotics and anti-viral medication to take for a few months after a kidney transplant.

• Haemorrhage (bleeding):

  • This can occur during or soon after any operation.

  • During a kidney transplant, the typical signs of bleeding might not occur so it can sometimes be harder to assess.

• Blood clots:

  • Blood clots can develop in the blood vessels (the vein or the artery) that have been connected to the donated kidney.

  • In some cases, it may be possible to dissolve the blood clots by using medication. However, the donated kidney often has to be removed if the blood supply is blocked. This is one of the commonest causes of the kidney transplant failing early on.

• Narrowing of the artery connected to the donated kidney:

  • This can sometimes occur after a kidney transplant. In some cases, it can develop months, or even years, after the transplant.

  • The artery often needs to be stretched to widen it, and a small tube called a stent may be placed inside the affected artery to stop it narrowing again.

• Blocked ureter:

  • The ureter is the tube that carries urine from the kidney to the bladder, and it can become blocked after a kidney transplant. It can be blocked soon after the transplant, or may occur months or years later, usually due to scar tissue.

  • It may be possible to unblock the ureter by draining it with a small tube passed into the ureter and above the blockage. Sometimes an operation may be needed to unblock the ureter.

• Urine leakage:

  • After surgery, urine may occasionally leak from where the ureter joins the bladder. This usually occurs during the first month after the transplant.

  • A urine leak usually needs a further operation to repair it.

• Acute rejection:

  • Acute rejection means your immune system suddenly begins to attack the donated kidney because it recognises it as foreign tissue.

  • Despite the use of immunosuppressants, acute rejection is a common complication in the first year after a transplant, affecting up to 1 in 3 people.

  • In many cases, acute rejection does not cause any symptoms and is only detected by a blood test.

  • If it does occur, it can often be successfully treated with a short course of more powerful immunosuppressant medicines.

Long-term complications

Long-term complications are mainly due to the side-effects of immunosuppressant medicines. Immunosuppressants can cause a wide range of side-effects, including:

• An increased risk of infections.

• An increased risk of diabetes.

• High blood pressure.

• Weight gain.

• Abdominal pain.

• Diarrhoea.

• Extra hair growth or hair loss.

• Swollen gums.

• Bruising or bleeding more easily.

• Thinning of the bones(osteoporosis).

• Acne.

• Mood swings.

• An increased risk of certain types of cancer, particularly lymphoma or skin cancer.

Even if you develop any side-effects, you should never suddenly stop taking your medication because your kidney could be rejected. Speak with your doctor or transplant team for advice.

How long do kidney transplants last?

How long a transplanted kidney lasts depends on a number of different factors. These include whether or not the kidney came from a living donor, how well the kidney is matched in terms of blood group and tissue type, and the age and overall health of the person receiving the kidney.

About 3-4 in 10 kidney transplants fail over the first 10 years after the operation.

If you have a kidney transplant that fails, you will need to go back on dialysis but you can often be put on the waiting list for another transplant. About 4 in 100 people receiving dialysis in the UK have had a failed transplant. About 16 in 100 people on the waiting list for a kidney transplant have had a previous failed transplant.

Kidney donations

Unlike many other types of organ donation, it's possible to donate a kidney while you're alive because you only need one kidney. This is called a living donation.

People who want to be considered as a kidney donor are tested to ensure they are a suitable donor and are fit for the operation needed to remove a kidney. Living donations are usually from a close relative because they are more likely to share the same tissue type and blood group. This reduces the risk of the body rejecting the kidney. Donating a kidney is a major operation and has risks which is another reason why this is usually from a close relative as they are more likely to accept these risks for someone whom they love.

Kidney donations are also possible from people who have recently died. This is known as deceased kidney donation. This type of kidney donation has a slightly lower chance of long-term success than a living donation. People who need a kidney transplant, but don't have a suitable living donor, will have to wait until a suitable deceased donor kidney becomes available.

Demand for kidney donations from recently deceased people is much greater than the number of kidneys available. There are strict guidelines about how donations are allocated. Children and young adults are generally given priority because they'll most likely gain long-term benefit from a transplant. For older adults, a scoring system is used to determine who should be given priority for a kidney transplant.

The NHS Organ Donor Register

All countries in the UK now have an 'opt-out' system where it is assumed you have no objection to donation when you die, unless you register that you do have an objection. Wales was the first country to adopt this in 2015, followed by England in 2020, Scotland in 2021 and Northern Ireland in 2023.

There is still an NHS Organ Donor Register which is quick and simple to join. You can opt out via this register as well.