Kidney Transplant Program
About Kidney Transplants
If you or someone you know are considering a kidney transplant, it is important that you completely understand the benefits, risks, and limitations of transplantation so you can make an informed decision.
Your success as a kidney transplant recipient depends in part on your understanding of what to expect before, during, and after your transplant surgery.
Kidney Transplant Program
The kidneys are two bean-shaped organs located on either side of the spine behind the upper abdominal organs. About one fourth of the blood volume pumped during each heartbeat goes to the kidneys. This adds up to about 160 quarts of blood every 24 hours. From this, about 1½ quarts of urine are eliminated through the bladder. The kidneys filter the blood using tiny components called nephrons and glomeruli.
The kidneys perform several critical functions, including:
- Filtering the blood of waste products that can become toxic if left to accumulate
- Removing excess fluid that can accumulate around the heart and lungs
- Returning nutrients to the bloodstream
- Producing a substance that helps regulate blood pressure
- Producing a substance necessary for red blood cell creation, thus preventing anemia
Kidney Failure Symptoms
The most common causes of kidney failure include:
- Hypertension (high blood pressure)
- Diabetes mellitus
- Kidney stones
- Inherited kidney disease
- Inflammatory disease of the nephrons and glomeruli
- Side effects of drug therapy for other diseases
- When your kidneys fail to remove waste products from the blood, a condition known as uremia develops. Since you normally have more kidney functioning ability than you need, most people do not develop symptoms of kidney failure until 90 percent of kidney function is lost.
Kidney Failure Treatment Strategies
Once kidney failure occurs, replacement of kidney function is needed and can be accomplished a few different ways.
- Peritoneal Dialysis: fluid exchange treatments are performed daily or nightly for at least eight hours using a surgically placed tube dwelling in the abdomen.
- Hemodialysis: requires using a surgically created superficial circulation called a fistula or artificial graft or using a temporary catheter inserted into a large central vein. Hemodialysis is typically performed at least three times per week for about three to four hours and requires pumping the patient’s blood through an external machine for filtration.
- Transplantation: The best currently available treatment for kidney failure is kidney transplantation from either a deceased or live donor. Transplantation requires a matching donor, abdominal surgery, and maintaining successful levels of immune suppressing medication to avoid rejection. One main advantage of transplantation over dialysis is quality of life as many are able to return to a more normal lifestyle. The five-year survival rate for transplantation is over 80%.
Kidney Transplant Waiting List
Kidney failure creates an opportunity for you to seek a life-saving organ transplant. Patients should consider all options, including first and foremost, live kidney donation through a living donor program. Living donor kidneys come from healthy donors who have been extensively screened and have the potential to live long healthy lives after donation. Due to the critical shortage of deceased donors, live donor kidneys can in many cases be more readily available by comparison. Living donor kidneys often have excellent function and can produce greater long-term success compared to deceased donor kidneys. Emory encourages all patients with kidney failure to pursue a living kidney donor, while waiting on the United Network for Organ Sharing (UNOS) wait list for a possible deceased donor. Patients may wait many years before getting an offer for a deceased donor kidney transplant. The wait for a kidney depends on the availability of organs, your blood type, your tissue type, and your level of preexisting anti-HLA antibodies.
The United Network for Organ Sharing (UNOS) provides a toll-free patient services line to help transplant candidates, recipients, and family members understand organ allocation practices and transplantation data. You may also call this number to discuss problems with your transplant center or the transplantation system in general. The toll-free patient services number is 1-888-894-6361.
Anxiety While Waiting is Normal
Helpful ways of coping with the stress of waiting for a kidney may include:
- Keeping up your normal daily routines as much as possible.
- Talking with someone on your team to help sort out your feelings. This could include your transplant coordinator, social worker, or physician. While waiting for a transplant, just "checking in" with your coordinator on a regular basis allows you to get questions answered and talk about any anxiety you may be having.
- Contacting the Georgia Transplant Foundation's Mentor Project. This program has been developed to match people who are new to the world of transplantation with people who are living with a transplant. You can get more information on the Mentor Project during your evaluation
Kidney Transplant Surgery
Kidney transplant surgery lasts about three hours. After arriving in the operating room, you will be given general anesthesia and put to sleep. The surgeon will make an incision on one side of your lower abdomen (usually the right side for first transplants) and the donor kidney will be placed in your pelvic area where it will be well protected. The blood vessels from the kidney will be connected to your large blood vessels. A small incision is made in the top of your bladder, and the ureter (the tube that connects the kidney and the bladder) will be stitched to your bladder. This allows the urine from your new kidney to flow down to your bladder.
A ureteral stent is usually placed during the transplant surgery. A stent is a hollow plastic tube that is inserted inside the ureter to help keep it open while it heals. You will be informed if you receive a stent during surgery so you can receive the appropriate follow-up. Staples or dissolvable stitches will be used to close the incision.
After Kidney Transplant Surgery
Tubes and monitoring equipment will be used to check your recovery progress after surgery. You can expect to wake up from surgery with an IV line in your arm, a larger IV in your neck (central line), a small tube called a foley catheter in your bladder to collect your urine, and EKG pads on your chest to monitor your heartbeat. When you wake up, you will be in the recovery room. Then you will be transferred to either the transplant floor or the surgical intensive care unit (ICU).
Initially you will be under the effects of anesthesia; you will be sleepy and may not remember the first time your family visits. During your recovery period, we will frequently check your vital signs, draw blood and collect urine for lab tests, monitor your urine output, and administer medications. In order to monitor your kidney function, you may have some of the following tests:
- Serum Creatinine: This blood test measures kidney function. It is checked each day while you are in the hospital.
- Renal Scan: This test monitors blood flow to the kidney and kidney function.
- Renal Ultrasound: This test checks the kidney for any blockages or fluid collections around the kidney.
- Kidney Biopsy: This test is used to check for rejection.
- You can expect to spend three to five days in the hospital after surgery. Your nurses will help you regain your strength, teach you how to care for yourself when you go home, and prepare you for discharge from the hospital. Close follow-up is essential for the success of your transplant, so after you are discharged, you may need to return to the transplant clinic daily for a few days for lab work.
Going home after your transplant is exciting, but it can also be overwhelming. Before you go home, we will thoroughly review with you and your family what you need to do to take care of yourself and your new kidney. Your transplant coordinator, pharmacist, social worker, and nurses will begin preparing you for discharge the day after surgery.
You need to weigh yourself every day. Please try to do this at about the same time each day (preferably in the morning after you have emptied your bladder) and while wearing about the same amount of clothing. If you have gained more than three pounds in a day, or more than five to seven pounds in a week, you should call the transplant team. This weight gain may be a side effect of your medications or possibly a sign of transplant rejection.
Medical Alert Identification
We suggest that you obtain a special medical alert bracelet or necklace. In case of a car accident or other type of emergency, this will inform health care professionals that you have had a transplant. The identification bracelet or necklace can be purchased at many pharmacies or ordered through the mail for a nominal cost.
Clinic Visits and Lab Tests
Your kidney transplant follow-up appointments will take place in the Outpatient Transplant Clinic. On the day of discharge, we will schedule your first appointment.
For the first four weeks after your transplant, you must come to Emory twice a week for a follow-up lab work and typically a weekly visit with the transplant team. After four weeks, if all is going well, visits and lab work will be needed less frequently. Eventually, you will need a follow-up appointment at Emory only once a year.
Routine Blood Tests
Monitoring your blood through lab tests is one way that we can make sure your kidney is working well and check for possible side effects of your medications.
Ureteral Stent Removal
Most transplant recipients will have a ureteral stent placed as part of their kidney transplant surgery. The urine produced by your new kidney flows to your bladder through the ureter. The ureter came with the donor kidney and was connected to your bladder with a small incision. The stent is a thin, hollow tube which is placed inside the ureter to keep it open and allow the connection to your bladder to heal.
The ureteral stent needs to stay in place for about six weeks after the transplant. By this time, healing will be complete and your stent can be removed. A urologist who works with the transplant team will remove the stent during a brief procedure called a cystoscopy.
When to Call the Transplant Team
You should call the Transplant Team if you experience any of these symptoms, or any time anything about your health changes, even if it is not related to your transplant:
- Temperature of 100°F or greater
- Blood pressure greater than 170/100 for two readings in a row
- Weight gain of more than three pounds in a day or five to seven pounds in a week
- Cough, shortness of breath, sore throat, chills
- Nausea, vomiting or stomach pain
- Decreased appetite
- Blood in the urine or bowel movements, painful urination
- Increased pain, redness, or pus-like drainage at the incision
- Pain, tenderness or swelling in the area of the new kidney
- Feeling unusually tired
- Persistent headache or flu-like symptoms
- Any unexplained rash, sores, or bruising
- Swelling of the hands, feet or ankles
- Inability to take medications for any reason
- Anything that concerns you about your health
How Can We Help You Today?
Need help? We will be delighted to assist you today, so please call us at 404-778-7777. We look forward to hearing from you.
Emory's transplant programs continue to provide excellent transplant outcomes in patient and graft survival rates.
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