A kidney transplant is a delicate, highly sophisticated procedure

Types of Kidney Transplants
A kidney transplant can only happen when a kidney becomes available from a donor. Kidneys can come from two sources: living donors and cadaver donors .

• Living Donors
  Studies have shown that the longevity of kidneys taken from living donors is better than kidneys from cadaver donors. There are two designations for living donors: Living-Related and Living-Unrelated.

• Living-Related Donors:  In most cases, a living donor will be a member of your own family – a brother, sister, parent, or other relative.

• Living-Unrelated Donors:  Someone who is not genetically related to you (a husband, wife or friend, for example) may be a possible donor.

• Cadaver Donors
  If a living donation is not available to you, your name can be put on a waiting list for a kidney from someone who has recently passed away. These are healthy kidneys that are recovered from brain dead donors. The family of the person who has died donates the kidneys for transplant to give someone else the “gift of life.”

Waiting for a “Gift of Life”
There is no way to know how long you may be on the waiting list for a kidney from a donor who has passed away. It could take as little as a few weeks to several years. While you are waiting, blood work will be done every month to check your antibody levels. This will help your team find the kidney that is an acceptable match for you. It will also let your doctors know if your body may reject a specific kidney due to high antibody levels.

High antibody levels can result from a blood transfusion, pregnancy or previous transplant. If your antibody levels are high, it will be harder to find a compatible kidney for you and you may have a longer wait.

Distribution of Kidneys
Kidneys from deceased donors are distributed through the United Network for Organ Sharing (UNOS). This organization has a national list that is on computer. The list is kept up to date with all of the important information about patients waiting for kidneys. It operates 24 hours a day, every day of the year.

Whenever a kidney becomes available, a computer list is generated which allocates or distributes the kidney to an individual based on degree of match, time waiting and level of antibody in the blood.

Notification of Kidney Availability
No one can predict when a kidney may become available for you. However, your transplant team will work with you to arrange a contact system so that you can be notified immediately if a kidney does become available. You can be contacted by telephone, or through a beeper provided to you free of charge.

The kidney that you will receive will be stored in a cold, slushy solution and has a limited viability span. So, once you are called, you must be immediately available to come into the hospital. If we are unable to contact you when a kidney becomes available, then we must offer the kidney to the next person on the list.

In some cases you may be called as back-up. This means that there are other patients in front of you for this particular kidney. If they are not compatible or not available, you would receive the kidney.

Before your surgery, your transplant team will need to do a final check of your physical health, and your body’s ability to accept the transplant. So, a number of tests and procedures will be performed. You will also meet with members of your transplant team so that you will feel comfortable with the upcoming surgical procedures, and be familiar with therapies that will be necessary during your recovery.

Physical Examination
Before surgery, you will need to have a complete physical, as well as a chest X-ray, EKG and other blood and urine tests. If you recently had these studies done in the transplant department, they may not need to be repeated.

Tests and Procedures
Blood may also need to be drawn for final crossmatch testing in the tissue typing lab. In the event that this final crossmatch indicates that you may react with the donor and cause immediate rejection of the kidney, the surgery would be canceled.

If you have not had dialysis treatment recently, a treatment may be arranged before surgery

Respiratory Therapy
A respiratory therapist will give you an Incentive Spirometer to be used after surgery. This device encourages you to take deep breaths and the therapist will instruct you on its use. It is important to use this device after surgery as it will help speed your progress and decrease your chances of developing a respiratory infection after surgery.

Anesthesiology
You will also meet with an anesthesiologist. An anesthesiologist is a physician who delivers anesthesia during the surgery. The anesthesiologist will give you information and answer any questions that you may have.

Intravenous Line
An intravenous line (IV) will be placed in your arm or in a vein near your collar bone. This will enable your team to give you fluids and medications before, during and after surgery.

Removing Your Malfunctioning Kidneys
In most cases, your own kidneys will not be removed from your body during your transplant surgery. However, if you have had repeated infections or have extremely large kidneys from polycystic kidney disease, you may be advised to have them removed prior to the transplant surgery.

Surgical Procedures
Your transplant surgery will take approximately three-to-five hours.

Once you get to the operating room, the anesthesiologist will give you anesthesia so you will sleep during the surgery. Your new kidney will be placed in your pelvis. The blood vessels from your new kidney will be connected to your blood vessels. The ureter, (the tube that carries urine from the kidney to the bladder) will be connected to your bladder.

A tube (Foley catheter) will be placed in your bladder. This will provide drainage of urine from your bladder during recovery.

Recovering After Surgery
When your surgery has been completed, you will be taken to the Recovery Room or Intensive Care Unit, where you will be closely monitored for several hours. When your team feels you are ready, you will be moved to the transplant unit.

The First Few Days
While you are recovering, you will be closely monitored to be sure that you and your new kidney are doing well.

• You will be connected to a cardiac monitor for approximately 48 hours or until you are in stable condition.

• A catheter placed in your bladder during surgery will provide continuous drainage of urine from the bladder. The urine will travel through a tube to the outside, and then be collected in a bag. This enables accurate measurement of urine output. This continuous drainage of urine will help the bladder to heal. The urine may appear bloody for a few days. This is not uncommon. The catheter will remain in place usually for four days after your operation.

• Your heart and fluids will be monitored through an intravenous catheter placed near your collar bone.

• You will be asked to cough and take deep breaths every hour after the operation. This helps to mobilize the mucus which may have accumulated in your lungs during the operation. If this mucus is not cleared from your lungs, it can be an excellent place for bacteria to grow. This could result in infection.

In a couple of days you will be walking around the Transplant Unit as much as you can tolerate. This will help your lungs and body get back into shape.

Monitoring Your New Kidney
Your new kidney may be sluggish, and may not work well right away. If this is the case, you may need dialysis temporarily to help you feel well. In most cases the kidney will begin to work within two weeks.

Your doctors may evaluate the function of the transplant kidney with a nuclear scan or a renal ultrasound. These tests may be done frequently during your hospital stay to help your doctor identify any collection or blockage so it can be treated immediately.

Going Home
If all is going well, you may be discharged from the hospital in about 4-7 days. (Your discharge may occur sooner or later, depending on your condition). Your transplant coordinator will help you prepare for you’re return home and provide you with information to help you through your recovery at home.

Because rejection and other problems usually occur in the first few months, your team will want to continue monitoring your progress and condition very closely. So, you can expect to return frequently to the Transplant Clinic. As your condition stabilizes, visits to the clinic will become less frequent.

Medical problems of any nature must be called into the Transplant Office. A transplant nurse and physician are “on-call” 24 hours a day.

When you start feeling more like yourself, you can begin enjoying the social and professional activities that were not possible while your were on dialysis.

Medications
The human body protects itself against germs through the immune system. This system also fights against cells or tissues that your body does not recognize as yours. This includes the tissue of your “new” kidney.

To keep your body from rejecting (attacking) your new kidney, you will need to take drugs called immunosuppressants. You must take these drugs every day, as long as your new kidney is working. If you do not take these drugs you will lose the kidney. Immunosuppressants increase your risk of contracting infections or getting some forms of cancer.

Many immunosuppressants have side effects. However, every patient is different. Many experience no side effects at all, others experience a few or several. Immunosuppressants you may be taking, and their possible side effects, include:

• Neoral (Cyclosporine microemulsion)
  The dose of Neoral is individually regulated according to its level in your blood stream. That is why it is important to take this drug exactly as directed. You will usually receive higher doses right after you get your new kidney.
  • Side Effects: You may experience slight hand tremors, diabetes, heavy growth of body hair, high blood pressure, or swollen gums. This medication can have a toxic effect on kidney functions. Side effects often diminish after the first few months (after transplant) as the dose is decreased gradually by your doctor.

• Prograf (FK506, Tacrolimus)
  The dose of Prograf is individually regulated according to its level in your blood stream. So, it’s important to take this drug exactly as directed. Higher doses are prescribed immediately after the kidney transplant, or after an episode of rejection.
  • Side Effects: You may develop hand tremors and diabetes mellitus. These side effects (including diabetes) often diminish after several months as the dose is reduce by your doctor.

• Prednisone (steroids)
  Immediately after you get your new kidney, you will be receiving higher doses of prednisone. The dose will be decreased as quickly as possible.
  • Side Effects: Usually, Prednisone side effects are dose related. In other words, as the dose is decreased side effects also decrease. Possible side effects include weight gain, mood swings, acne, increased appetite, muscle weakness, diabetes, cataracts, increased blood pressure, stomach upset, osteoporosis, skin cancer, fat deposits on the cheeks, abdomen and back of the neck, joint pain, and slower healing of wounds.

• CellCept (Mycophenolate Mofetil)
  CellCept may lower your white blood cell count (WBC). This will be monitored closely and your dose will be adjusted as needed.
  • Side Effects: Some patients my have decreased WBC’s (this can put you at a higher risk of cold or infection), or stomach upset (nausea, vomiting, diarrhea).

• Thymoglobulin
  Given intravenously, this medication is prescribed for some patients temporarily after a transplant to suppress the immune system into accepting the new kidney and delay the use of Neoral or Prograf. The medication is usually given for 3 – 14 days, depending on how quickly your kidney works.
  • Side Effects: Thymoglobulin is made from rabbit protein, so it can be associated with allergic reactions. It may also decrease WBC and platelet counts.

• Daclizumab (Zenapax)
  This medication is given intravenously to some patients on the day of surgery and again two weeks later to decrease the possibility of your body rejecting the kidney.
  • Side Effects: Daclizumab has no known side effects but may increase the risk of infection and cancer.

• OKT3
  OKT3 is sometimes given to patients who are experiencing severe rejection in the new kidney. The drug is given through an intravenous line for 10-14 days.
  • Side Effects: You may experience shortness of breath, fever, chills, muscle aches, confusion and headaches.

Note: All immunosuppressants increase your risk of cancer or infection. Please consult with your physician.