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Kidney Transplant: What You Need to Know Before Surgery

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Posted by Serban Constantinescu, MD, PhD

If you have kidney failure or end-stage renal disease (ESRD), a kidney transplant may be a life-changing option for you. Just last year, more than 23,000 kidney transplants were performed in the U.S., making it one of the more common transplant procedures performed.

I’m the Medical Director of Temple’s Kidney Transplant Program. When my team and I meet and talk to patients about kidney transplant, they naturally have a number of questions. At this stage, they’ve been through a lot, and this is a big life-changing decision.

Our goal is to help patients feel good about our commitment to them, and that usually starts with helping them understand what they’ll go through. Kidney transplantation is a gift, and we want them to feel that too.

The information I’m sharing here is based on the most common questions we receive from patients:

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Should I stay on dialysis or have a kidney transplant?

When your kidneys no longer function properly due to kidney failure, your nephrologist usually offers you 2 options: dialysis or kidney transplant. Many times patients are on dialysis while they wait for transplantation, so it’s important to understand what that involves.

Our patients sometimes find dialysis to be restrictive, because appointments and maintenance take up a lot of time. Plus, dialysis only replaces part of your kidney’s function. It’s imperative that your nephrologist monitors you closely alongside your primary care provider to help ensure you’re receiving exceptional care.

With a successful kidney transplant, many of our patients are able to live more normally than with dialysis. That’s because life on dialysis means you are dependent on dialysis, which acts as your artificial kidney. With a kidney transplant, life is completely different. In my experience, it can help people get their lives back, and that’s truly a gift.

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How does a kidney transplant work?

During a kidney transplant, we replace your damaged kidney with one from a living donor or deceased donor. A transplant surgeon connects your new kidney to an artery and vein in your groin and to the ureter. This allows excess fluid and waste to be carried in the urine through the bladder from your new kidney.

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What’s the difference between deceased donor and living donor?

We’ve made quite a few advances in kidney transplant over the last 50 years. Today, you may receive your kidney from a donor who is living, or from someone upon their death:

A deceased donor is a person who decides to donate a kidney to help people who need transplants. Their family members can also make the decision.

A living donor can be a family member or friend, or someone whom you do not know who makes the decision to donate one of their kidneys.

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Is kidney transplant safe?

We make sure to always tell our patients that as with any surgery, kidney transplant does involve risks. You’ll be required to take medicines called immunosuppressants to help your body accept the new organ.

For many patients, kidney transplantation is an excellent option, even for patients who are usually considered high risk, including:

  • Older patients
  • People who are immunosuppressed
  • Those who have multiple conditions or comorbidities

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Is kidney transplant successful?

Both a deceased donor organ and a living donor organ are excellent life-changing options and are highly successful.

According to the August 2020 Scientific Registry of Transplant Recipients (SRTR) report, 1-year national expected survival rates are:

  • 98.11% success rate for living donor kidney transplant
  • 94.88% success rate for deceased donor transplant

At Temple, we perform at these levels or higher.

Deceased and living donor organ transplants have great odds, and here are other benefits to receiving a kidney from a living donor:

  • People who receive kidneys from living donors generally live longer than those who receive a kidney from a deceased donor.
  • Kidneys from living donors tend to last longer than those from deceased donors.
  • Kidneys from living donors tend to function almost immediately after surgery.

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What should I expect after my kidney transplant?

Our patients are generally out of bed and eating the day after their transplant, with the support of our nursing team. We make sure to tell our patients that in addition to their immunosuppressant medicines — which they’ll take for the rest of their lives — they may also receive antibiotics and pain relievers.

My advice is usually this: If you’re feeling well and your body is accepting the new organ, you may be released from the hospital within a few days.

In the weeks and months after your procedure, you’ll have regular check-ups and blood tests to ensure you’re healthy and your new kidney is functioning properly.

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I’ve heard of kidney transplant rejection. What is that and what are the symptoms?

Kidney rejection does happen, but it's rare. Your new kidney may take a while to start working properly or you may experience problems associated with the surgery itself, including bleeding or infection at the incision site. Immunosuppressant medicines also put you at greater risk for infection.

We advise our patients to call us if they notice any of the following:

  • Fever, or a lasting cold or cough
  • Seeping from surgical scar
  • Burning with urination

Keep in mind that you may not notice early signs of rejection, so routine blood tests after surgery are crucial. Look for high blood pressure or swelling. These are signals that your new kidney may not be functioning properly.

If you do experience problems, we’ll work closely with you. It may be that you need your medications adjusted or you might need to go on dialysis for a while as your body gets used to its new kidney.

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Where do I get a kidney transplant?

If you do decide to have a kidney transplant, you’ll need to work closely with a nephrologist who is associated with an accredited kidney transplant program with good patient outcomes. In general, the steps to have a kidney transplant include:

  1. Evaluation to see if you’re emotionally and physically healthy enough to receive a kidney.
  2. Working with your hospital’s financial counselor to review your insurance and talk to you about your finances to discuss options for covering the costs of transplantation.
  3. If you have a living donor — such as a family member or friend — they’ll need to undergo tests to make sure they can donate a kidney.
  4. If you do not have a living donor, you’ll be placed on a waiting list.
  5. As soon as a kidney is available, you’ll undergo kidney transplant.
  6. You’ll work with your kidney transplant team in the hospital just after surgery and in the coming weeks and months to ensure your body is accepting the new organ.

Kidney transplantation is an excellent choice. Just be sure to work with a team that has enthusiasm and passion, who is involved in active research, and who has an active database to connect you with the right donors.

Helpful Resources

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Serban Constantinescu, MD, PhD

Dr. Constantinescu is a nephrologist who performs both kidney and pancreas transplants. A Professor of Medicine at the Lewis Katz School of Medicine at Temple University, Dr. Constantinescu has research interests in the Hepatitis C virus infection in renal transplantation, and kidney dysfunction in non-renal solid organ transplantation.

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