Kidney transplant: what patients and families should know

What is this page for?

This page is for information only. Who is a candidate for a transplant, which centre performs it, or what the donation rules are in Iran are decisions for the transplant team, and this page makes no claims about them. The aim is to help patients and families learn the language and the path before they meet the transplant team.

What is a kidney transplant?

NIDDK says a kidney transplant places a healthy kidney from a donor into your body to take over the work of the failed kidneys, and stresses that it is “a treatment for kidney failure, not a cure.” The donor may be someone who has recently died or a living person close to you: a relative, spouse or friend. The surgeon usually places the kidney in the lower abdomen near the groin. NHS Blood and Transplant says the kidney is the most commonly transplanted organ, and that about 2,868 kidney transplants were done for adults in the UK in 2021/22; this is a UK figure and not a reference for Iran.

Who may benefit?

According to NIDDK, a person with kidney failure who is healthy enough for surgery and able to follow a daily medicine routine. The assessment includes blood tests, a check of the heart and other organs, and mental health. Some conditions, such as untreated cancer or active substance use, lower the chance of success. NHS Blood and Transplant also reminds readers that its explanations describe the “average patient” and that the transplant team gives an opinion on each person individually.

Matching and the waiting list

NIDDK says that for matching, the donor’s blood is tested against the recipient’s to see whether the body will accept the kidney. Relatives usually match better, and blood group also affects the waiting time. Donated kidneys are scarce, and the wait can be months to years. If the donor is living, the date of the operation is planned in advance. According to NIDDK, in the United States you can be placed on the waiting list once kidney function falls to 20 or below, even before dialysis starts.

After the operation

NIDDK says many patients feel better quickly after the operation and the hospital stay is usually a few days. The new kidney may make urine straight away or after a few weeks, and dialysis may be needed in between. Possible complications include bleeding, infection (especially bladder infection), hernia, and pain or numbness on the inner thigh. Visits with the kidney specialist and blood tests to monitor kidney function continue, with longer gaps over time.

Anti-rejection medicines and infection

NIDDK explains that these medicines must be taken every day so the body’s defences do not attack the new kidney. Their possible side effects include changes in appearance, weight gain, acne, extra hair growth, cataracts, diabetes, high blood pressure, weaker bones, and, with long-term use, liver or kidney damage and a higher risk of cancer. The transplant team follows medicine levels and organ function with regular tests. Because these medicines weaken the body’s defences, infection is more likely and its signs may be fainter. Never stop the medicine or change the amount yourself.

Rejection

NIDDK writes that rejection right after the operation is uncommon, but it may appear days or weeks later and happens less often with a living donor. Early rejection often has no symptoms, and regular tests are the key. Signs can include high blood pressure or swelling. It is usually treated by adjusting the medicine. If the kidney is lost, dialysis and a return to the waiting list may be needed, and some patients receive a second transplant.

Why does the urinary tract matter after a transplant?

The EAU says some urological problems can occur after a transplant. These figures come mostly from published studies, not predictions for any one patient:

• Urine leak (0 to 9.3 percent): sometimes treated with a stent, a catheter or a nephrostomy tube, and if that does not work, surgery is needed.
• Ureteral stricture (0.6 to 10.5 percent): strictures shorter than 3 cm are treated with methods through the urethra, and longer or recurring ones need surgery. The EAU says they usually have little effect on kidney and patient survival.
• Stones (0.2 to 1.7 percent): the sign is more often fever, a rise in creatinine, reduced urine or blood in the urine, and pain is usually not felt.
• Urinary infection: the EAU says removing the stent earlier (up to 7 days) reduces infection compared with later (14 days or more). About 13 percent of recipients have had acute pyelonephritis of the transplanted kidney. The EAU recommends a preventive stent to reduce major urinary complications.

A living donor also needs follow-up. The EAU writes that survival and the risk of kidney failure after donation are similar to the general population (kidney failure in 0.4 to 1.1 percent), and recommends that all living donors have long-term follow-up.

A reminder

This page is for general information and does not replace a conversation with your transplant team. If you or someone close to you has a transplanted kidney and develops fever, burning when passing urine, swelling or reduced urine, contact the transplant team the same day.