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.
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:
The most common causes of kidney failure include:
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.
Once kidney failure occurs, replacement of kidney function is needed and can be accomplished a few different ways.
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.
Helpful ways of coping with the stress of waiting for a kidney may include:
When you arrive at Emory for your transplant, your coordinator will direct the check-in process. Some final testing will be done to make sure you are healthy enough for surgery. These tests may include chest X-ray, EKG, blood and urine tests, and a health history and physical exam.
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.
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:
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.
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.
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.
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.
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.
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:
