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Kidney transplant

Unlike many other types of organ donation, it is possible to donate a kidney while you are alive because you only need one kidney to survive.

Unlike many other types of organ donation, it is possible to donate a kidney while you are alive because you only need one kidney to survive. This is known as a living donation.

Ideally, living donations will come from a close relative because they are more likely to share the same tissue type and blood group as the recipient, which reduces the risk of the body rejecting the kidney. However donations from those who are not blood relatives are sometimes possible.

Kidney donations are also possible from donors who have recently died. However, this type of kidney donation has a slightly lower chance of long-term success.

Who can be a living donor?

There is no upper age-limit for choosing to make a living kidney donation, but you will usually need to be 18 or over.

If you decide to donate one of your kidneys, you will need to attend a series of appointments so that:

  • your blood group and tissue type can be determined, to check your compatibility with potential recipients (see below)
  • the state of your kidneys can be checked
  • your general health can be assessed
  • tests can be carried out to see if you have any serious illnesses that could affect the donation, such as HIV or hepatitis C

This assessment procedure can take 3-6 months, and some overnight stays at a specialist transplant centre may be required.

Checking compatibility

One of the biggest risks of receiving a donated kidney is that your immune system will mistake the donated kidney for foreign tissue. If this happens, your immune system will attempt to destroy the kidney. This is known as rejection.

To minimise the risk of rejection, the kidney should ideally be donated by a donor to a recipient who shares the same:

  • tissue type - human tissue carries a special genetic 'marker' or code, known as a human leukocyte antigen (HLA); ideally, you should receive your transplant from someone with a very similar HLA tissue type
  • blood group - as with tissue, red blood cells carry a specific antigen marker

For these reasons, family members are usually the most suitable donors. Members of the same family often share the same genes so they are more likely to have matching HLA tissue types and blood groups.

However, many kidney transplants have been successfully performed using compatible donations not taken from a family member.

Removing your kidney

Your kidney can be removed using:

  • laparoscopic (keyhole) surgery - a type of minimally invasive surgery that involves making several small incisions (cuts), through which fine instruments are used to remove the kidney
  • open surgery - where the kidney is removed through a single, larger incision

Laparoscopic surgery has the benefits of reduced scarring and a faster recovery time then open surgery, but it can only be performed by a surgeon with special expertise in the procedure so it may not always be an option.

Both types of operation are carried out under general anaesthetic, which means you will asleep during the procedure and won't experience any pain while it is performed.

See how kidney transplants are performed for information about what happens with your donated kidney once it is removed.

Recovery

You will usually need to stay in hospital for up to seven days if you have open surgery to remove one of your kidneys, whereas you can usually go home in 3-4 days after keyhole surgery.

You will need to take it easy for a few weeks after the procedure. You can usually return to work within about 3-4 weeks, but you may need more time off if you have an active and strenuous job.

Risks

As with any type of surgery, removing a kidney has risks. However, most complications associated with the procedure are relatively minor and treatable.

The most common problems that occur after the operation are infections - including wound infections, urinary tract infections and chest infections. It's estimated that about 1 in every 3 donors develop an infection of some sort after surgery.

More serious complications, such as blood clots or severe bleeding, occur in about 1 in every 100 cases. However, such problems can be identified and treated quickly.

The risk of dying after surgery to remove one of your kidneys is very small, occurring in less than 1 in every 3,000 cases.

It's important to make sure you fully understand all risks associated with kidney donation before you consent to the procedure.

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Kidney transplant

A kidney transplant is the transfer of a healthy kidney from one person (the donor) into the body of a person who has little or no kidney function (the recipient).

A kidney transplant is the transfer of a healthy kidney from one person (the donor) into the body of a person who has little or no kidney function (the recipient).

The main role of the kidneys is to filter waste products from the blood and convert them to urine. If the kidneys lose this ability, waste products can build up, which is potentially dangerous and can be life threatening.

This loss of kidney function, known as end stage chronic kidney disease or kidney failure, is the most common reason for needing a kidney transplant.

It is possible to partially replicate the functions of the kidney using a blood filtering procedure known as dialysis, but this can be both inconvenient and time-consuming so a kidney transplant is the treatment of choice for kidney failure whenever possible.

Who can have a kidney transplant?

Most people who need a kidney transplant are able to have one, regardless of their age, as long as:

  • they are well enough to withstand the effects of surgery
  • the transplant has a relatively good chance of success
  • the person is willing to comply with the recommended treatments required after the transplant – such as taking immunosuppressant medication and attending regular follow-up appointments

Reasons why it may not be safe or effective to perform a transplant include having an ongoing infection (this will need to be treated first), heart disease, liver failure, cancer that has spread to several places in your body (metastatic cancer), and AIDS (the final and most serious stage of an HIV infection).

However, people who have HIV that is being effectively controlled with medication can often have a kidney transplant.

Kidney donations

Unlike many other types of organ donation, it is possible to donate a kidney while you are alive because you only need one kidney to survive. This is known as a living donation.

People who want to be considered as a kidney donor are tested very carefully to ensure they are a suitable donor and are fit for the operation needed to remove a kidney.

Ideally, living donations will come from a close relative because they are more likely to share the same tissue type and blood group as the recipient, which reduces the risk of the body rejecting the kidney. However donations from those who are not blood relatives are sometimes possible.

Kidney donations are also possible from people who have recently died. This is known as deceased kidney donation. However, this type of kidney donation has a slightly lower chance of long-term success.

Read more about donating a kidney.

Waiting for a kidney

People who need a kidney transplant, but do not have a suitable living donor, will have to wait until a suitable deceased donor kidney becomes available. This will ideally be from a donor with the same tissue type and blood group as the recipient, to reduce the risk of the body rejecting the kidney.

On average, the waiting time for a deceased donor kidney transplant is about three years. Waiting times are so long because the demand for donated kidneys in the UK is far higher than the available supply of donors.

From April 2012 to April 2013, around 3,000 kidney transplants were carried out in the UK, but there were still more than 6,000 people on the waiting list for a kidney by the end of this period.

Kidney donors are particularly required from people of non-white ethnic origin because rates of kidney disease are especially high in people of South Asian, African and Caribbean ethnic origin, but there are not many donors from these communities.

Read more about the kidney transplant waiting list.

The transplant procedure

If you receive a kidney from a living donor, this will be a carefully planned operation.

If you are waiting for a deceased donor kidney, the transplant centre will contact you if a suitable kidney becomes available. This can happen at any time of the day or night. Staff at the centre will check you don't have any new medical problems and will ask you to go to the centre, where final checks will be performed to be sure it is right for the transplant to go ahead.

You will then have surgery to insert the new kidney and connect it to your blood vessels and bladder. The new kidney will be placed in the lower part of your abdomen (tummy). Your own kidneys will usually be left in place.

A kidney transplant is a major surgical procedure with a wide range of potential risks. In the short term, these risks include blood clots and infection. Longer term problems, which include diabetes and an increased risk of infections, are usually related to the immunosuppressant medication that needs to be taken continuously to reduce the chance of rejection.

Because of the risk of further problems, people who have had a kidney transplant require regular check-ups for the rest of their life.

Read more about how a kidney transplant is performed and the risks of a kidney transplant.

Living with a kidney transplant

Having a healthy lifestyle after a kidney transplant goes a long way to minimising the risk of complications.

Therefore, it’s recommended that you:

  • stop smoking if you smoke
  • eat a healthy diet
  • lose weight if you are overweight or obese
  • take steps to reduce your risk of developing infections

Read more living with a transplant.

How long do kidney transplants last?

There are a number of factors which affect how long a transplanted kidney may last. 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, the age of the person receiving the donation, and the overall health of the person receiving the donation.

Overall, average kidney survival times are:

  • 1 year – 85-95%
  • 5 years – 70-80%
  • 15 years – 50-60%

If you have a kidney transplant that fails, you are usually suitable for another transplant from either a living or deceased donor.


 

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Kidney transplant

Ideally, a kidney transplant should be performed when testing shows the extent of damage to your kidneys is so great that you will require dialysis within six months.

Ideally, a kidney transplant should be performed when testing shows the extent of damage to your kidneys is so great that you will require dialysis within six months.

However, because of the lack of available kidneys, it is unlikely you will receive a kidney donation at this time unless a family member or friend who has a similar tissue type to you is willing to make a living donation.

Most people with kidney failure need dialysis while they wait for a donated kidney to become available.

The average time a person spends on the waiting list for a kidney transplant is about three years. People with rarer blood groups or tissue types tend to wait longer.

How donations are allocated

Demand for donations from recently deceased people far outstrips supply so there are strict but necessary guidelines about how donations are allocated.

Children and young adults are given priority if a matched donation becomes available as they will most likely gain a long-term benefit from donation.

For older adults, a scoring system is used to determine who should get a donation. The score is based on factors such as how long you have been on the waiting list and how well matched the donor is in terms of tissue type, blood group and age.

Waiting for a transplant

If you are on the waiting list for a kidney, the transplant centre will need to contact you at short notice once a kidney becomes available so you must inform staff if there are any changes to your contact details.

You should also inform staff if there are changes to your health – for example, if you develop an infection.

While waiting for a donated kidney to become available, it is important you stay as healthy as possible by doing the following:

  • eating a healthy diet – read more about healthy eating
  • taking regular exercise if possible – read more about exercise and getting fit
  • moderating your consumption of alcohol – recommended limits for alcohol consumption are three to four units a day for men and two to three units a day for women; read some tips on cutting down
  • stopping smoking if you smoke – read more about stopping smoking

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

Transplant centres

In England, there are 20 NHS specialist kidney transplant centres. Six centres are in London, and a further 14 are in the following cities:

  • Birmingham
  • Bristol
  • Cambridge
  • Coventry
  • Leeds
  • Leicester
  • Liverpool
  • Manchester
  • Newcastle
  • Nottingham
  • Oxford
  • Plymouth
  • Portsmouth
  • Sheffield

Read about how a kidney transplant is performed.



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Kidney transplant

Although rates of serious complications have fallen sharply in the last few decades, kidney transplants - like any other type of surgery - are not risk free.

Although rates of serious complications have fallen sharply in the last few decades, kidney transplants – like any other type of surgery – are not risk free.

The risks of a kidney transplant can arise from a number of factors:

  • risks related to the procedure itself
  • risks related to the use of immunosuppressant medications (medications that reduce the activity of your immune system)
  • risks related to something going wrong with the transplanted kidney

Most complications occur in the first few months after a transplant, but complications can still develop after many years.

Both short-term and long-term complications of a kidney transplant are discussed below.

Short-term complications

Infection

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

More serious infections, such as pneumonia and cytomegalovirus, can occur and may require treatment in hospital.

Blood clots

Blood clots can develop in the arteries that have been connected to the donated kidney. This is estimated to occur in around one in every 100 kidney transplant cases.

In some cases, it may be possible to dissolve the blood clots using medication, but it is often necessary to remove the donated kidney if its blood supply is blocked.

Narrowing of an artery

Narrowing of the artery connected to the donated kidney, known as arterial stenosis, can sometimes occur after a kidney transplant. In some cases, it can develop months or even years after the transplant.

Arterial stenosis can cause a rise in blood pressure. The artery often needs to be stretched to widen it, and a small metal tube called a stent is often placed inside the affected artery to stop it narrowing again.

Obstruction of the ureter

The ureter (the tube that carries urine from the kidney to the bladder) can become blocked after a kidney transplant. It can be blocked soon after the transplant, for example by blood clots, or this can happen months or even years later, usually due to scar tissue forming.

It may be possible to unblock the ureter by draining it with a small tube called a catheter. Sometimes surgery may be required to unblock the ureter.

Urine leakage

Occasionally, urine may leak from where the ureter joins the bladder after surgery. This usually occurs during the first month after surgery. The fluid may build up in the abdomen or leak through the surgical incision.

If you develop a urine leak, you will usually need to have further surgery to repair it.

Acute rejection

Acute rejection means the 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 an estimated one in five people.

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

Acute rejection can often be successfully treated with a short course of more powerful immunosuppressants.

Long-term complications

Immunosuppressant side effects

Immunosuppressants prevent your body's immune system from attacking the new kidney, which would cause the transplanted kidney to be rejected.

A combination of two or three different immunosuppressants is usually taken long term.

These can cause a wide range of side effects, including:

  • weight gain
  • abdominal pain
  • diarrhoea
  • extra hair growth
  • swollen gums
  • bruising or bleeding more easily
  • acne

The doctor in charge of your care will be trying to find the right dose that is high enough to 'dampen' the immune system sufficiently to stop rejection, but low enough that you experience very few or no side effects.

Finding the optimal dose to achieve both goals is often a difficult balancing act. It may take several months to find the most effective dose that causes the least amount of side effects.

Side effects should improve once the right dosage is identified. Even if your side effects become troublesome, never suddenly stop taking your medication because your kidney could be rejected.

Diabetes

Diabetes is a common complication of having a kidney transplant.  

Diabetes is a lifelong condition that causes a person's blood sugar level to become too high. Some people develop it after a kidney transplant because, as they no longer feel unwell they eat more and gain too much weight. Some types of immunosuppressants can also make you more likely to develop diabetes.

Symptoms of diabetes include:

  • feeling very thirsty
  • going to the toilet to urinate a lot, especially at night
  • tiredness

Diabetes can often be controlled using a combination of lifestyle changes, such as changes to your diet, and medication. Read more about treating diabetes.

High blood pressure

High blood pressure is also a common long-term complication of a kidney transplant.

Many people who require a kidney transplant already have an increased risk of developing high blood pressure and taking immunosuppressants can make the condition worse.

High blood pressure usually causes no noticeable symptoms but can increase your risk of developing other serious, and in some cases fatal health conditions such as coronary heart disease, heart attacks and strokes.

Because of the risk of high blood pressure, you will have your blood pressure checked every time you attend one of your follow-up appointments. In addition to this you can check your own blood pressure at home with a simple device available from most chemists.

Read more about checking your blood pressure.

Cancer

The long-term use of immunosuppressants also increases your risk of developing some types of cancer, particularly types of cancer known to be caused by viruses (as you will be more vulnerable to the effects of infection).

These include:

  • most types of skin cancer
  • Kaposi’s sarcoma – a type of cancer that can affect both skin and internal organs
  • lymphoma – a cancer of the lymphatic system 

You can help reduce your risk of skin cancer by avoiding exposure to the sun during the hottest part of the day and by applying complete sun block to your lips and all exposed areas of your skin every day, regardless of whether or not it is sunny.

Your care team will be able to provide more advice on your individual risks, whether you require regular check-ups and any early signs to watch out for.



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Kidney transplant

Ivy Ashworth-Crees talks about how much better her life is since her double kidney and pancreas transplant.

Ivy Ashworth-Crees talks about how much better her life is since her double kidney and pancreas transplant.

"About 32 years ago, I started to have diabetes and had to have insulin injections four times a day. I also had to work hard on my diet to make sure I didn’t eat too much sweet food.

"After about 25 years, I got kidney failure and, in 2003, I had to go on kidney dialysis. The kidney dialysis was very uncomfortable. It was a drain, having to do it four times a day, as well as having to have the diabetes injections four times a day. I felt like my life was on hold.

"I was on kidney dialysis for two years when they put me on the list to have a kidney transplant. The surgeon suggested that I could probably benefit from a kidney and a pancreas transplant, which meant I wouldn’t be a diabetic any more.

"When I got the phone call to say that I was going to Manchester for the transplant, I was absolutely hysterical. I was a bag of emotions, both thrilled and terrified.

"When I came round after the operation, I was in intensive care. I stayed there for about three or four days, then I was taken to the main ward.

"The most difficult part was getting out of bed and starting to walk. They walked me up and down the ward for weeks until my legs got strong enough. That was very, very difficult. The pain was very bad, but it’s all been worth it.

"The doctor asked me to try to reduce my weight, so I joined the gym. I enjoy swimming. I think it’s helping me to keep active. The only problem is that I can’t walk too far.

"It’s vital that I take the immunosuppressant drugs. If I don’t, my body could reject the kidney and pancreas. I have to take them for the rest of my life.

"My life’s changed dramatically. I now take it for granted that I can eat what I want, including chocolates! I’m back at work, I don’t have an injection after my meals, I don’t have to rush home for dialysis and my kidneys and pancreas are working well.

"I feel blessed that I’ve been through this operation and it’s worked so well."

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Kidney transplant

When Dr Carole Angel donated a kidney to her brother, Paul Whitaker, she was able to go home just 48 hours after surgery

When Dr Carole Angel donated a kidney to her brother, Paul Whitaker, she was able to go home just 48 hours after surgery.

Paul, a self-employed builder from Preston, was diagnosed with end-stage kidney failure in October 2001. "I was astonished to find out I had renal failure," he says. "After a series of headaches, I went to the optician because I thought I needed glasses. He tested my blood pressure and it was so high he sent me straight to my doctor."

He began dialysis in the summer of 2002, but his condition rapidly deteriorated and he was soon registered for a transplant.

His older sister Carole was working as a pathologist in Sheffield. She says: "Paul has always been a strong, tall man, but his illness began to take its toll. He lost three stone in weight."

Paul's family were worried about him. "It was worse for Mum, Dad and our brothers, as they all lived closer to him and could see the daily effect on him," says Carole. "I knew one of us should donate a kidney, and it just happened to be me.

"I don't see Paul very often but we have always kept in touch by telephone. When I told him I was willing to donate a kidney, he said that he couldn't ask me to go through with it. I told him he wasn't asking; I was offering. We can be quite stubborn in our family.

"The decision to donate wasn't taken lightly. I had to go through a series of hospital tests and received a lot of psychological support. The whole process took many months. I felt a special responsibility to make sure that my health was good enough to help Paul. The worst thing was not knowing whether it would all go ahead."

Around Christmas 2002, the possibility of 'keyhole' surgery was mentioned by the doctors. It was a relatively new procedure for the Manchester renal transplant unit but offered the great advantage of being much better for the donor, with a shorter hospital stay and quicker recovery time.

However, not all living kidney donors are able to have this technique. It wasn't until Carole woke up after the operation in March 2003 that she knew it had been successful.

"I had the operation on a Thursday morning and was home by lunchtime on Saturday, just 48 hours later. It was incredible. When I was 21, I had my appendix out and that was far worse than the kidney donation operation."

Paul recalls waiting to go into surgery a few hours after his sister. "I must admit, I was worried about what she might be going through. But we managed to see each other as I was being wheeled into theatre and she was being wheeled out. She was very groggy and doesn't remember much, but it gave me a great boost to see her.

"When I eventually came out of surgery, I was wheeled past the side ward where Carole was recovering and she saw me, which made her feel better."

Both Carole and Paul have fully recovered. "The whole experience has changed my outlook on life," says Carole. "Paul is always so positive about things. He always looks on the bright side and this has rubbed off on me."

Paul is back at work again, living life to the full. "I'm overwhelmingly grateful to Carole for what she did for me. She gave me back my life, and I can never thank her enough."

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