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Renal transplant

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Renal transplant



Introduction 

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.

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.

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.

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



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.


 





Kidney transplant: Tony's story




 




Tony talks about his recovery from a kidney transplant and his goal of climbing Mount Everest.


Media last reviewed: 16/05/2013

Next review due: 16/05/2015







The  Organ Donor Register

In the UK, consent is required before organs can be donated. A person can give their consent to become an organ donor after death by joining the  Organ Donor Register or by discussing their wishes with loved ones.

Alternatively, a person’s organs can be donated if consent is obtained after their death from an authorised person, such as a relative or friend.

The  Organ Donor Register is the same in principle as carrying a donor card, but is a failsafe way of ensuring your wishes are made clear. A donor card can be lost or forgotten about, but joining the register will mean there's a permanent record of your wishes that doctors can check in the event of your death.

Joining the  Organ Donor Register is quick and simple, and will only take a few minutes of your time. You can remove yourself from the register at any time, and you can specify what you're willing to donate.

 





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Waiting for a 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.

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



taking regular exercise if possible



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



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 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



 

Organ donation - sign up today





If you needed an organ transplant, would you have one? If so, please help others.



Organ donation sign up

First name(s) *

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Year


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 Waiting for a 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.

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 die



taking regular exercise if possible



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 



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  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.




 

Organ donation - sign up today


If you needed an organ transplant, would you have one? If so, please help others.



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First name(s) *

Last name *  


Date of birth *

Day

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Year


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  Risks of a 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.

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

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.

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.











 

  Living with a kidney transplant   

The lifestyle advice below is usually recommended if you have had a kidney transplant.

Stop smoking

If you smoke, it is strongly recommended you stop as soon as possible because smoking can reduce the life of your new kidney and can increase your risk of developing some types of cancer.

The  Smokefree website can provide support and advice to help you stop, and your GP will also be able to recommend and prescribe medication that can help.

Most people are able to enjoy a much more varied diet after a kidney transplant, although you may be advised to avoid some foods after the operation until the kidney is working properly.

During the early stages after a transplant, while you are on higher doses of immunosuppressant medication, you should avoid eating foods that may cause food-borne infections such as listeriosis. For example, you should avoid:



unpasteurised cheese, milk or yoghurt



foods containing raw eggs (such as mayonnaise)



undercooked meats, fish and shellfish



Once your kidney is working properly and the best immunosuppressant dose for you has been identified, you will usually be advised to follow a generally healthy diet as this can help reduce your risk of complications such as diabetes.

A healthy diet should consist of:



plenty of fruit and vegetables – at least five portions of fruit and veg a day



plenty of potatoes, bread, rice, pasta and other starchy foods; ideally you should choose wholegrain varieties 



some milk and dairy foods 



some meat, fish, eggs, beans and other non-dairy sources of protein 



a small amount of food and drink high in fat and sugar



Also avoid food that contains high levels of salt, as salt can cause high blood pressure, which can be dangerous in people with a kidney transplant. See facts about salt for more information and advice.

Exercise and weight loss

Once you have made a sufficient physical recovery from the effects of surgery, it is recommended that you do regular physical activity.

Adults should do at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity every week.

The definition of moderate intensity physical activity is any activity that increases your heart and breathing rate and may make you sweat but you are still able to hold a normal conversation.

Examples include:



fast walking



riding a bike on level ground or with few hills



swimming



tennis



Choose physical activities that you enjoy, as you are more likely to continue doing them.

It is probably unrealistic to meet these exercise targets immediately if you have not exercised much in the past. So you should aim to start gradually – possibly 15 to 20 minutes of exercise five times a week – and then build on it.

If you are overweight or obese it is recommended you try to achieve a healthy weight. This can be safely done through a combination of eating a healthy calorie-controlled diet and regular exercise.

It is normally recommended you aim for a body mass index (BMI) of between 18.5 and 25.

Alcohol, drugs and medications

Regularly drinking alcohol above limits recommended by the  will raise your blood pressure, which can be dangerous in people with a kidney transplant.

Therefore, you should not exceed the recommended limits of:



three to four units a day for men



two to three units a day for women



Alcohol is also high in calories, so you will gain weight if you drink regularly. Being overweight will also increase your blood pressure

You should also avoid taking any illegal drugs after a kidney transplant, as they can damage your kidneys, cause a sudden rise in blood pressure and react unpredictably with your immunosuppressant medications.

Finally, always check with your care team before taking any medication, including over-the-counter medication and herbal remedies such as St John's wort, as some medications could be potentially harmful if you have had a kidney transplant and are taking immunosuppressant medication.

Immunosuppressants and infection

If you have a kidney transplant, you will usually need to take immunosuppressant medications for the rest of your life to prevent your body's immune system from attacking the new kidney.

Widely used immunosuppressants include:



tacrolimus



ciclosporin



sirolimus



azathioprine



mycophenolate



prednisolone



However, taking immunosuppressive medications on a long-term basis will weaken your immune system and make you more vulnerable to infections, so you will need to take extra precautions against infection:



Avoid contact with people with serious infections, such as chickenpox or influenza (flu).



Practise good personal hygiene – wash your hands regularly with soap and hot water, particularly after going to the toilet and before preparing food and eating meals.



If you cut or graze your skin, clean the area thoroughly with warm water, dry it, then cover it with a sterile dressing.



Also ensure your vaccinations are up to date, although you will not be able to have any vaccines that contain live viruses, such as the measles, mumps and rubella (MMR) vaccine.

When to seek medical advice

If you think you may have an infection, contact your GP or transplant centre for advice. Prompt treatment may be required to prevent serious complications developing.

Symptoms of infection include:



a high temperature (fever)



headache



aching muscles



diarrhoea

 
Renal transplant