Reason for A kidney transplant.

Kidney transplantation is a procedure that places a healthy kidney from another person into your body. This one new kidney does all the work that your two failed kidneys cannot do.

How it Works
A surgeon places the new kidney inside your body between your upper thigh and abdomen. The surgeon connects the artery and vein of the new kidney to your artery and vein. Your blood flows through the new kidney and makes urine, just like your own kidneys did when they were healthy. The new kidney may start working right away or may take up to a few weeks to make urine. Your own kidneys are left where they are, unless they are causing infection or high blood pressure.

Getting Ready
You may receive a kidney from a member of your family. This kind of donor is called a living-related donor. You may receive a kidney from a person who has recently died. This type of donor is called a cadaver donor. Sometimes a spouse or very close friend may donate a kidney. This kind of donor is called a living-unrelated donor.
 

It is very important for the donor's blood and tissues to closely match yours. This match will help prevent your body's immune system from fighting off, or rejecting, the new kidney. A lab will do special tests on blood cells to find out if your body will accept the new kidney.
 

To see the video, click on the picture to the right. Once you are transferred to the new web site, click the word at the top of the window 'undefined' to drop down the menu. Select kidney transplant, then click on slides to view the slides. Once done viewing the slides, click on video to allow the video to load and play. Once you are done watching the video, click your browser's exit button to close out that page and return here.

PRETRANSPLANT EVALUATION
Pretransplant tests, as well as giving a clear picture of the patient's overall health status, help in identifying potential problems before they occur. They also help in determining whether transplantation is truly the best option. This increases the likelihood of success.

The following procedures help in evaluating a patient's health status:

Physical exam - Gives the doctor an overall picture of the patient's conditions.

Chest x-ray - Determines the health of the patient's lungs and lower respiratory tract.

Complete medical and surgical history - Determines what additional tests may need to be done.

Electrocardiogram (EKG or ECG) - Determines how well the patient's heart is working and may reveal heart damage that was previously unsuspected.

Ultrasound with Doppler examination - Determines the quality of the iliac vessels.

Blood tests - The patient's blood count, blood and tissue type, blood chemistries, and immune system function will all be checked. In addition, blood tests for certain infectious diseases will be performed.

Pulmonary function test - The patient will be asked to breathe into a tube attached to a measuring device, which will reveal how well his lungs are working and determine his blood's capacity to carry oxygen.

Upper gastrointestinal (GI) series - This will show whether the patient's esophagus and stomach are disease free.

Lower GI series - Ensures that the patient is free of intestinal abnormalities.

Renal function studies - Urine may be collected from the patient for 24 hours in order to determine if the kidneys are working correctly. Blood tests such as serum creatinine are also performed to measure kidney function.

Viral testing - Determines if the patient has been exposed to hepatitis, cytomegalovirus (CMV), Epstein-Barr (EBV), or acquired immune deficiency syndrome.

Mammogram - X-ray of a woman's breast that can detect signs of breast cancer.

Pap smear - Cells collected from a woman's cervix that are microscopically analyzed for signs of cancer.

Echocardiogram - Reveals any abnormalities in the heart.

Dental Evaluations - You need to have a dental check-up before you will be listed for transplant. Your dentist must tell us that your teeth and gums are healthy. You will also need to be checked by your dentist every year while you are waiting for your transplant.

Heart Catheterization - checks the status of the arteries that feed your heart. This test helps to make sure that your heart can tolerate the stress of transplant surgery. This test is done by feeding a catheter through an artery (usually an artery in the groin) up to the heart arteries so that contrast dye can be injected into the coronary arteries to view them. Contrast dye can be toxic to the kidneys, so your doctor must decide if a heart catheterization is right for you.

Histocompatibility Laboratory Tests
Tissue Typing - This test is done on white blood cells. The white blood cells have special "markers" that tell your "tissue type". You inherit tissue type from your mother and father. This test is used to match a kidney and/or pancreas to you.

 
Panel Reactive Antibody (PRA) - This test shows how active your immune system is. It is easier for you to get a kidney if your immune system is calm or measures 0%. Blood will be drawn at your dialysis center and sent to our laboratory. Your immune system may be active from blood transfusions, pregnancy, a previous transplant or a current infection.

Crossmatch Testing - This test is done when a donor kidney is available. Your blood is mixed with the donor's blood. If there is no reaction (negative crossmatch) it means you are "compatible" with the donor. If there is a reaction (positive crossmatch), the kidney will not work for you because it is "incompatible".

Other Tests - The transplant doctors will ask for any special tests they think you will need. For example, people with diabetes will need more tests for their heart. Your transplant coordinator or dialysis doctor can help you make arrangements for these tests.



Clinical Laboratory Tests
Blood Typing - There are four different blood types. They are A, B, AB and O. Every person has one of these blood types. The donor's blood type does not have to be the same. However, it must be "compatible" with your blood type for you to receive the kidney and/or pancreas.
Viral Testing - It is important for us to know if you have been exposed to hepatitis, cytomegalovirus (CMV), Epstein-Barr virus (EBV), or acquired immune deficiency syndrome (AIDS). We will test you for these at your clinic appointment.


PREPARING AND WAITING FOR A KIDNEY TRANSPLANT
The Telephone as a Lifeline
As soon as a donor kidney becomes available, the coordinator will call the recipient to get ready. Since this call could come at any time during the day or night, the transplant team should be able to reach the patient whether he is at home, at school, at work, or on vacation. If possible, the patient should invest in a telephone answering machine with remote control so he can check messages while away from home. A pager or cell phone is also very helpful in staying in contact with the transplant team.

The patient should provide his team with the phone numbers of family members and close friends as well, and do everything he can to make sure that he can be contacted immediately.

When the Phone Call Comes

When that phone call comes, everything will seem like a blur. The coordinator will advise the patient when to be present at the transplant center. The patient must move quickly, getting to the transplant center without delay. When a kidney becomes available, there is a time limit!

Make a List and Pack Ahead of Time
The patient should pack an overnight bag in advance as soon as his name is put on the waiting list. He should make a list of items he will need in the hospital after surgery, as well as a list of people to be contacted when the kidney becomes available. The patient should give this list ahead of time to a trusted family member or friend to pack any last-minute items and make the calls while the patient is on his way to the transplant center.

Getting to the Transplant Center
If the transplant center is nearby, the patient should plan to have a designated driver - if possible, someone who will be standing by when the phone call comes. This person should be available at all times and reachable by phone. The route to the transplant center should be mapped out in advance.

If the transplant center is farther away, the coordinator may assist the patient and family with transportation arrangements.

If the patient chooses to make his own travel arrangements, he should call the airlines in advance, and get regularly updated information about flight times and routes every month. If possible, a direct flight is the best option. Because flights might be delayed, the patient should have a backup plan. Choose another airline as a backup, or another mode of travel (bus, train, etc.).

To make it easier on loved ones, they should arrange to stay within driving distance of the transplant center.

Dealing With Pretransplant Stress
Waiting for a transplant can trigger a patient's feelings of stress and anxiety. To help manage stress, the patient should:

Eat right, take prescribed medications, and follow a daily exercise program. The transplant team will create a plan based on his medical needs.

Keep up with studies, work, and leisure activities, to the best of his abilities. The patient shouldn't have to put everything on hold.

Share his feelings if he feels depressed or uneasy. The transplant team can answer questions, and help alleviate fears. The social worker is more than a good listener -- he or she can put the patient in touch with a support group in the area.

Find a creative outlet, enjoying a hobby to the fullest. This will distract and help a patient relax. Or the patient could pursue a new interest - something that will absorb pent-up energy and leave positive feelings of fulfillment. The patient should ask his doctor for guidelines on these activities.

Spend time with family and friends. Good company will take a patient's mind off waiting. Laughter really is the best medicine.

Learn relaxation techniques, like reading and listening to music or relaxation tapes.
 

When that important phone call comes, the patient should make sure to bring the following to the hospital:
A list of all the medications the patient is taking
A list of the patient's drug allergies, if he has any
The patient's health insurance information
IMPORTANT: As soon as a kidney is available, the patient should stop all eating and drinking immediately. The patient's stomach must be empty when he is taken into the operating room.

AT THE HOSPITAL
After admission, the patient will have a thorough physical examination, including more blood work, a chest x-ray, and EKG, dialysis and, possibly, other tests.
Unfortunately, surgery must be postponed in some cases. The patient will be sent home again if:

He has an infection or has developed any other medical problem that would interfere with surgery or recovery
The donor kidney shows signs of deterioration or poor function
If surgery is postponed, the transplant team can help the patient through the disappointment. This is only a temporary setback, and the search for a new kidney will go on.

PREPARING THE PATIENT FOR SURGERY

Before the operation, the patient may receive an enema or a laxative to clean out his intestines and prevent constipation after surgery. Hair from the chest and abdomen will be shaved to prevent infection, and an intravenous (IV) line will be inserted in the arm or just under the collarbone to give medication and prevent dehydration. The patient will also be given a sedative to help him relax and feel sleepy before going to the operating room.
IMPORTANT:
Because transplantation is a major surgical procedure, the patient may need a transfusion. Today, all blood is screened very carefully; the likelihood of contracting a disease is very small. Any concerns that the patient has regarding the source of the blood should be relayed to the transplant team during the waiting period, before getting to the hospital. Most hospitals offer the option of "autotransfusion" - this is when the patient donates his own blood before surgery. His own blood is stored and then used during transplantation.

THE KIDNEY TRANSPLANT SURGERY PROCEDURE
The patient will be under general anesthesia throughout the surgery. Once asleep, the transplant surgeon will make an incision on the right or left side of the lower abdomen just above the groin.


The surgical team will then place the donor kidney into the abdomen and connect the kidney's blood vessels to the recipient's iliac artery and vein. The surgeons will then connect the ureter to the bladder. A small drain, called a Jackson Pratt, may be placed into the abdominal cavity to drain any excess fluid.


WAKING UP IN THE INTENSIVE CARE UNIT (ICU)
After the surgery, the patient will wake up in the intensive care unit (ICU) after the anesthesia wears off.
This is what the patient should expect:

Some pain and discomfort, which medication will help to relieve.

The patient will be asked to cough periodically to keep his lungs clear. If it hurts to cough, the patient should ask someone to support his abdomen.

 

The patient will have an IV line in his arm or neck under the collarbone, which will be used to give fluids and medication for the first few days after surgery.

For several days after surgery, the patient will have a catheter in his bladder to drain urine. He may feel uncomfortable, and may feel that he has to urinate constantly, but it is only temporary.

During surgery, one drain may be placed in or near the incision. The drain will be removed 5 to 10 days after surgery.

Dialysis may still be needed to help clear excess fluid and toxins in the body until the kidney recovers from the procurement process.
 

The length of a hospital stay will depend on a patient's progress. A patient is encouraged to talk to someone on his transplant team if he is uneasy or uncomfortable.

CLINIC VISITS
Upon leaving the hospital, the patient will receive a schedule of follow-up clinic visits for lab tests and checkups. The purpose is to track your progress and detect potential complications as early as possible.
 

Follow-up visits

On days when the patient is scheduled for follow-up visits, he should bring his medication list and his surgery handbook. He will be given specific instructions for routine lab work or special tests that he might need.


LAB TESTS
A usual lab test monitors blood count, kidney function, electrolytes, and medication levels in the patient's blood. Other tests may be ordered as necessary.

Tests for BLOOD COUNT:

WBC tell if the patient's white blood cells have increased (usually a sign of infection) or decreased (indicating a lower defense against infection).

HCT measures the hematocrit, which is the percentage of red blood cells in the blood. Red blood cells carry oxygen to all parts of the body. When a patient's HCT is low, he may feel tired or have little energy.

PLT measures the level of platelets. Platelet cells form a blood clot when the body is injured. Low platelet levels may cause someone to bruise easily and to bleed for a longer time when injured.
 

Test for KIDNEY FUNCTION:

Creatinine and BUN tell how well the kidneys work by measuring levels of creatinine and blood urea nitrogen, waste products normally removed from the blood by the kidneys.

Tests for ELECTROLYTES (dissolved minerals):

Ca measures calcium, which is necessary for strong bones and teeth, blood clotting, and heart and nerve function.

PO4 measures phosphate, which works closely with calcium to strengthen bones.

Mg measures magnesium, which is necessary for normal functioning of muscles and for blood clotting.

K measures potassium, which is needed for normal heart and muscle function.

Na measures sodium, which helps maintain the balance of salt and water in the body.

CO2 measures bicarbonate, which helps maintain acid balance in the body.

Creatinine measures how well the kidneys are functioning. When this number rises, the cause may be rejection or a side effect of medication.
 

Other blood tests:

Drug levels measure Tacrolimus (Prograf®) or Cyclosporine (Sandimmune®) in the blood. Tacrolimus or Cyclosporine blood levels must be checked regularly to avoid levels that are too high or too low. High levels could lead to toxicity or over-immunosuppression, and low levels may lead to rejection.

NOTE: The desired level (normal range) will differ for each person, depending on the combination of immunosuppressive medications and the length of time since the transplant.

Glu measures glucose, levels of sugar in the blood; some medications may produce a diabetes-like condition in which blood-sugar levels are too high.


ADDITIONAL TESTS AND PROCEDURES
The transplant team may perform one or more of the following tests and procedures to monitor a patient's transplant:
 

Ultrasound - This test is performed to make sure all the main blood vessels leading to the kidney are functioning normally. This test is also used to check for collections of fluid, such as blood. The procedure consists of placing a cool gel on the patient's abdomen, over which a wand (transducer) is moved to transmit sound waves. These are converted into images of the kidney and projected onto a television screen.

Kidney biopsy (test sample) - This test is usually performed to check for rejection, or other possible problems. This may be done in the hospital or in the outpatient/short-stay unit. The patient will receive special instructions regarding the procedure. Before the procedure, the patient will receive a numbing injection (local anesthetic) on the side of his abdomen where the transplant organ is. Then a special needle will be inserted to withdraw a small sample of kidney tissue that will be examined with a microscope.

Computerized tomography (CT) scan - This is a type of X ray that allows the physician to view the patient's kidney from many different angles to detect infections, fluid collections, or other problems. The procedure requires that the patient drink a liquid that outlines his stomach and intestines and makes his kidney more visible; then he lies flat for 1 hour while the machine takes X rays around him.

Magnetic resonance imaging (MRI) - This is another type of test that produces an image. Somewhat like a CT scan, it also allows a patient's kidney to be viewed from different angles and in three-dimensional images. An MRI shows soft tissues, such as the kidney, more clearly than a CT scan does.


MONITORING HEALTH AND A NEW KIDNEY AT HOME
After a patient is discharged from the hospital, he may be asked to monitor:
temperature
pulse
blood pressure
weight
Temperature - A patient should check and record temperature any time he feels chilled, hot, achy, or ill. This may be the first sign of infection.

WARNING: DO NOT USE TYLENOL®, ADVIL® (Ibuprofen), aspirin, or other such products except under the direction of a physician, as these drugs may cause further symptoms.

If a patient's temperature is higher than normal at any time, he should notify his transplant coordinator immediately. This is considered an emergency, because an elevated temperature could indicate a serious infection or rejection.

Blood pressure - A nurse or transplant coordinator will show how to measure blood pressure, if necessary. The top number (systolic) is noted at the first sound, and the bottom number (diastolic) is noted when the sound changes (not stops). It is important that a patient knows his normal blood pressure, normal changes, and when he should be concerned.

Pulse - If a patient is taking medication that affects heart rate, the nurse or coordinator will show how to check his own pulse at home.

NOTE: If a patient experiences chest pain or has difficulty breathing, he should call 911 for an ambulance and go to the nearest emergency room. He SHOULD NOT attempt to drive himself.

Weight - The patient may weigh himself on a standard bathroom scale at the same time every morning (after going to the toilet). If he gains more than 2 pounds per day, he could be retaining fluid. This should be reported to the transplant coordinator.

AVOIDING INFECTION
Because immunosuppressive medications interfere with a patient's natural immune system, he needs to protect himself consciously from infection after the surgery by taking the following precautions:

Wash hands often.

Keep hands away from face and mouth.

Stay away from people with colds or other infections.

Ask friends to visit only when they are well.

If the patient has a wound and must change his own dressing, wash hands before and after.

Wash hands after coughing or sneezing, and throw tissues into the trash immediately.

If someone in the patient's family becomes ill with a cold of flu, have that individual follow normal precautions (use separate drinking glasses, covering their mouths when coughing, etc.)

Avoid working in the soil for 6 months after the transplant. Thereafter, wear gloves.

Avoid handling animal waste and avoid contact with animals who roam outside. Do not clean bird cages or fish or turtle tanks or cat litter. The cat litter box should be covered and taken out of a patient's home before it is changed.

Avoid vaccines that consist of live viruses, such as Sabin oral polio, measles, mumps, German measles, yellow fever, or smallpox. The live virus can cause infections. If a patient or any family member intends to receive any vaccinations, they should notify the transplant team or local physician.

Take good care of your teeth by brushing two times a day and seeing the dentist twice a year for cleaning and checkup.
 

SPECIAL WARNING TO PARENTS OF CHILDREN
WHO HAVE HAD TRANSPLANTS:
Ask the school nurse or other official to notify you immediately of any communicable diseases (for example, measles, chicken pox) that may be circulating in your school.


 

A patient should notify the transplant team if he:

has prolonged illness (nausea, vomiting, diarrhea).
is unable to take medicines by mouth due to illness.
thinks the directions on the label may be different from what he was told.
has trouble removing child-resistant caps.
has a reason to take aspirin, TYLENOL® (acetaminophen), other pain relievers, or cold remedies.
feels he is having a reaction to the medications.
has had a change in health or eating habits.
has a new prescription from his local doctor or a change in a current prescription.
experiences any unusual symptoms or side effects, as they may be related to the medications he is taking.
is undergoing dental work of any kind.

 

The Time it Takes
The time it takes to get a kidney varies. There are not enough cadaver donors for every person who needs a transplant. Because of this, you must be placed on a waiting list to receive a cadaver donor kidney. However, if a relative gives you a kidney, the transplant operation can be done sooner.

The surgery takes from 3 to 6 hours. The usual hospital stay may last from 10 to 14 days. After you leave the hospital, you will go to the clinic for regular followup visits.

If a relative or close friend gives you a kidney, he or she will probably stay in the hospital for one week or less.

Possible Complications
Transplantation is not a cure. There is always a chance that your body will reject your new kidney, no matter how good the match. The chance of your body accepting the new kidney depends on your age, race, and medical condition.

Normally, 75 to 80 percent of transplants from cadaver donors are working one year after surgery. However, transplants from living relatives often work better than transplants from cadaver donors. This fact is because they are usually a closer match.

Your doctor will give you special drugs to help prevent rejection. These are called immunosuppressants. You will need to take these drugs every day for the rest of your life. Sometimes these drugs cannot stop your body from rejecting the new kidney. If this happens, you will go back to some form of dialysis and possibly wait for another transplant.

Treatment with these drugs may cause side effects. The most serious is that they weaken your immune system, making it easier for you to get infections. Some drugs also cause changes in how you look. Your face may get fuller. You may gain weight or develop acne or facial hair. Not all patients have these problems, and makeup and diet can help.

Some of these drugs may cause problems such as cataracts, extra stomach acid, and hip disease. In a smaller number of patients, these drugs also may cause liver or kidney damage when used for a long period of time.

Your Diet
Diet for transplant patients is less limiting than it is for dialysis patients. You may still have to cut back on some foods, though. Your diet probably will change as your medicines, blood values, weight, and blood pressure change.


You may need to count calories. Your medicine may give you a bigger appetite and cause you to gain weight.
You may have to limit eating salty foods. Your medications may cause salt to be held in your body, leading to high blood pressure.
You may need to eat less protein. Some medications cause a higher level of wastes to build up in your bloodstream.
 

Pros and Cons
There are pros and cons to kidney transplantation.

• Kidney Transplantation

• Pros

• It works like a normal kidney.

• It helps you feel healthier.

• You have fewer diet restrictions.

• There's no need for dialysis.
  
  Cons
   

• It requires major surgery.

• You may need to wait for a donor.

• One transplant may not last a lifetime. Your body may reject the new kidney.

• You will have to take drugs for the rest of your life.
   

Working With Your Health Care Team
Questions You May Want To Ask


Is transplantation the best treatment choice for me? Why or why not?
What are my chances of having a successful transplant?
How do I find out if a family member or friend can donate?
What are the risks to a family member or friend if he or she donates?
If a family member or friend doesn't donate, how do I get placed on a waiting list for a kidney? How long will I have to wait?
What are the symptoms of rejection?
Who will be on my health care team? How can they help me?
Who can I talk to about sexuality, finances, or family concerns?
How/where can I talk to other people who have faced this decision?

Conclusion It's not always easy to decide which type of treatment is best for you. Your decision depends on your medical condition, lifestyle, and personal likes and dislikes. Discuss the pros and cons of each with your health care team. If you start one form of treatment and decide you'd like to try another, talk it over with your doctor. The key is to learn as much as you can about your choices. With that knowledge, you and your doctor will choose a treatment that suits you best.

Paying for Treatment Treatment for ESRD is expensive, but the Federal Government helps pay for much of the cost. Often, private insurance or state programs pay the rest.

Medicare
Medicare pays for 80 percent of the cost of your dialysis treatments or transplant, no matter how old you are. To qualify, you must have worked long enough to be insured under Social Security (or be the child of someone who has) or you already must be receiving Social Security benefits.

You should apply for Medicare as soon as possible after beginning dialysis. Often, a social worker at your hospital or dialysis center will help you apply.

Private Insurance
Private insurance often pays for the entire cost of treatment. Or it may pay for the 20 percent that Medicare does not cover. Private insurance also may pay for your prescription drugs.

Medicaid
Medicaid is a state program. Your income must be below a certain level to receive Medicaid funds. Medicaid may pay for your treatments if you cannot receive Medicare. In some states, it also pays the 20 percent that Medicare does not cover. It also may pay for some of your medicines. To apply for Medicaid, talk with your social worker or contact your local health department.

Veterans Administration (VA) Benefits
If you are a veteran, the VA can help pay for treatment. Contact your local VA office for more information.

Social Security Income (SSI) and Social Security Disability Income (SSDI)
These benefits are available from the Social Security Administration. They assist you with the costs of daily living. To find out if you qualify, talk to your social worker or call your local Social Security office.

U.S. Transplant Games

Imagine, 1,500 organ transplant recipients gathered together at an event to celebrate the miracle of transplant. That's what happens at the U.S. Transplant Games sponsored every other year by the National Kidney Foundation. The games offer transplant recipients of all ages the opportunity for competition and a celebration of life after transplant.