Kidney transplantation is the removal of a healthy kidney from a living or recently deceased person and then its transfer into a person with end-stage kidney failure.
For people of all ages who have irreversible kidney failure, kidney transplantation is a lifesaving alternative to dialysis. Kidney transplantation is the most common type of organ transplantation procedure.
Kidney transplantation is indicated when people have:
Advanced, irreversible kidney failure
In the United States, about 85% of transplanted kidneys come from previously healthy, deceased donors. About one-third of these kidneys are damaged but are used because the demand is so great. The rest of transplanted kidneys come from living donors. Donation from a living donor is possible because the donor can live with one healthy kidney.
Both donors and recipients undergo pretransplantation screening. This screening is done to be sure that the organ is healthy enough for transplantation and the recipient does not have any medical conditions that would prohibit transplantation.
Kidney transplantation is not recommended for certain medical conditions, such as a severe heart disease or some types of cancer. In the past, some other conditions, such as poorly controlled diabetes or certain viral infections like hepatitis C, also prevented people from receiving a transplant. However, due to advances in medical therapies, many of these conditions can be managed well enough to allow transplantation. People with these conditions still require special precautions and close monitoring, because the medications needed to prevent rejection can sometimes worsen the underlying condition.
Older adults in their 70s and sometimes 80s may qualify for transplants if the following apply:
They are healthy in other respects, can function independently, and have good social support.
They are expected to live a reasonably long time.
Transplantation is likely to substantially improve their ability to function and their quality of life beyond simply freeing them from dialysis.
People who also have type 1 diabetes may be candidates for simultaneous pancreas-kidney or pancreas-after-kidney transplantation.
One year after transplantation, about 97 to 99% of kidney recipients are alive. The percentage of transplanted kidneys still functioning is about 95 to 98%.
At 5 years after kidney transplantation, approximate survival rates are:
For kidneys from living donors: 93%
For kidneys from deceased donors: 86%
Transplanted kidneys sometimes function for more than 30 years.
People with successful kidney transplants can usually lead normal, active lives.
Procedure for Kidney Transplantation
Kidney transplantation is a major operation. The person receiving the kidney is usually on dialysis in the months or years before the transplant procedure.
The kidneys are removed from the donor, usually using thin instruments and a small video camera inserted through several tiny incisions (laparoscopic surgery). Occasionally, a larger incision (open surgery) is required. After removal, the kidney is cooled and transported quickly to a medical center for transplantation to a person who has a compatible blood and tissue type and who does not make antibodies to the tissues of the donor.
The donated kidney is placed in the recipient's pelvis through an incision and is attached to the recipient’s blood vessels and bladder. Usually, the nonfunctioning kidneys are left in place. Occasionally, they are removed because infection develops and does not resolve.
Medications to inhibit the immune system (immunosuppressants), including steroids (sometimes called glucocorticoids or corticosteroids), are started the day of transplantation. These medications can help reduce the risk that the recipient will reject the transplanted kidney.
Complications of Kidney Transplantation
Rejection
Various complications can occur during or after kidney transplantation. Some are related to the surgery itself, like bleeding, blood clots, and obstruction or leakage where the ureter connects to the bladder. Others are related to the need for lifelong medications that suppress the immune system, which can increase the risk of rejection, infection, and certain types of cancer.
Even if tissue types are closely matched, the recipient's body will reject transplanted organs, unless measures are taken to prevent rejection. Rejection results from an attack by the recipient's immune system on the transplanted organ, which the immune system recognizes as foreign material. Rejection can be mild and easily controlled or severe, resulting in destruction of the transplanted organ.
Despite the use of immunosuppressants, one or more episodes of rejection may occur after kidney transplantation.
Acute rejection occurs within a few days to a few months of kidney transplantation. It can be accompanied by fever, decreased urine production with weight gain, pain and swelling of the kidney,and elevated blood pressure. Blood tests show deteriorating kidney function. Because these symptoms can also result from infections or use of a medication, the diagnosis of rejection sometimes needs to be confirmed with a needle biopsy of the kidney.
Chronic rejection that develops over many months to years is relatively common and causes kidney function to gradually deteriorate.
Rejection can usually be effectively treated with high doses of steroids or other medications. If these medications are ineffective, they are gradually stopped, and dialysis must be started again. Dialysis is continued until another kidney transplant is available.
The rejected kidney may be left in place unless fever, tenderness, or blood in the urine persists. The chance of success with second transplants is almost as good as that with first transplants.
Cancer
Compared with the general population, kidney transplant recipients are about 2 to 4 times more likely to develop cancer, probably because the immune system helps defend the body against cancer. Cancer of the lymphatic system (lymphoma) is 30 times more common among kidney transplant recipients than the general population, but lymphoma is still uncommon. Skin cancer is common.
Viral infections
Certain viral infections (cytomegalovirus and BK virus) decrease the likelihood the transplanted kidney will survive. Epstein-Barr virus infection may increase the risk of an overgrowth of white blood cells (post-transplant lymphoproliferative disorder). People with a kidney transplant are also at a higher risk of serious illness from common respiratory viruses such as Influenza and COVID-19.
