What to Expect from a Kidney Transplant
Two kidneys are responsible for cleaning all the blood in the body. They work in tandem to remove harmful wastes and unnecessary liquids. Fortunately, for those with kidney failure, a single, donated kidney — or a kidney transplant — can do the job just fine.
Kidney transplants regularly save thousands of Americans each year. In fact, according to the Scientific Registry of Transplant Recipients, live or deceased donor kidney transplants are successful at the 1-year mark more than 95% of the time.
“There are few gifts greater than a patient receiving a new kidney,” says Winfred Williams, MD, a Mass General Brigham nephrologist. “You’re essentially given a second chance to live the life you want.”
Dr. Williams serves as associate chief of Nephrology at Massachusetts General Hospital. He explains how a kidney transplant saves a life, and how that life changes after receiving one.
What is kidney disease?
Every 30 minutes, your entire blood supply passes through the kidneys. Tiny structures inside the kidneys, called nephrons, serve as miniature filters. Each kidney contains about 1 million nephrons. They filter the blood, eliminating wastes, toxins, and excess fluid. The kidneys pass these wastes and fluids into tubes called ureters, which extend from each kidney to the bladder. Your body releases these waste products from the bladder as urine.
Healthy kidneys also:
Balance salts and minerals in the blood. Two examples: potassium and sodium. Both are electrolytes, or minerals with an electrical charge when dissolved in water. Each are essential for body functions.
Help control blood pressure
Produce a hormone responsible for stimulating the production of red blood cells inside bone marrow
Keep bones strong by regulating calcium and phosphorus
Kidney disease is among the leading causes of death in the United States. The condition increases rates of high blood pressure (hypertension), heart disease, and stroke. It can be either chronic or acute:
Chronic kidney disease (CKD): A slow or progressive decline in kidney function, which can occur over months or years. The condition increases the risk of stroke and heart disease.
- Acute kidney failure (acute renal failure): A rapid decline in kidney function, which can occur within days or weeks
Kidney failure
When kidney function drops below 15% its normal level, kidney failure, or end-stage renal disease (ESKD), occurs. The two main causes of ESKD are diabetes and high blood pressure.
Health problems from low kidney function include:
Fatigue and weakness
Impaired brain function
High blood pressure
Loss of appetite, or nausea
Confusion, problems with memory, or depression
Bone and heart disease
What are the benefits of a kidney transplant compared to dialysis?
Hundreds of thousands of Americans live with ESKD, and each one relies on either dialysis or a kidney transplant to stay alive.
There are two types of dialysis:
- Hemodialysis (HD): This is the most common treatment for advanced kidney failure in the U.S. During HD, your blood is pumped through soft tubes to a special, computerized dialysis machine. The machine filters your blood several times. Acting as an artificial kidney, it removes waste products and toxins from the blood, balances electrolytes, and removes excess fluid. Patients usually have HD in a free-standing dialysis clinic, 3 times a week, 4 hours per session. Home HD is an option for carefully selected patients.
- Peritoneal dialysis (PD): A surgeon places a soft tube, or catheter, inside your abdomen. Through the tube, you self-administer several liters of a dialysis solution. The solution contains prescribed amounts of electrolytes and minerals. It exchanges those electrolytes and minerals with waste products and excess fluids from the bloodstream. After several hours, you use a special bag to drain the fluid from your abdomen, removing the excess waste and fluid and leaving electrolyte levels restored. The procedure occurs several times a day. Some patients use an automated PD dialysis procedure, called a cycler, that performs PD exchanges every few hours while they sleep. One advantage of PD: It can be done anywhere at the convenience of the patient.
Dialysis can limit activities and diet. Those on hemodialysis must live close enough to a dialysis center for regular treatment. Their work and social lives revolve around their appointments. Without a functioning kidney to balance nutrients in the blood, they can easily fall ill from eating or drinking foods and beverages high in:
Potassium: Too much can affect the electrical activity of your heart, causing abnormal changes in heart rhythm, called arrythmia. This can lead to cardiac arrest or sudden death.
Phosphorus: Too much can lead to life-threatening cardiovascular events, such as heart attack and stroke, as well as weakened bones.
Sodium: Too much can make you thirsty, prompting you to drink excess fluids the kidneys cannot process.
“Dialysis, in and of itself, is a lifesaving treatment,” says Dr. Williams. “A kidney transplant, however, allows patients to free themselves from many of the restrictions set by dialysis. Their quality of life can improve quite dramatically. A well-functioning kidney transplant not only affords a better quality of life, but it also increases longevity.”
According to Dr. Williams, patients who receive a durable, well-functioning kidney can live 10 to 15 years longer than those who remain on dialysis.
Who is a good candidate for a kidney transplant?
Unfortunately, not everyone who needs a new kidney receives one. You must first meet with a doctor to confirm if you are healthy enough to undergo surgery for a transplant. If your doctor considers you healthy enough, they refer you to a transplant center, which conducts further tests.
Transplant centers evaluate for:
Tissue and blood type, as well as the health of the heart, liver, and lungs.
Conditions or illnesses, many of which can make a transplant less likely to succeed. Cancer in remission, chronic infections, or substance use disorder, are a few such conditions.
Mental and emotional health, to ensure you can understand and follow a medication schedule following surgery. Patients will need to comply with complicated instructions involving several drugs.
Who can donate a kidney?
Candidates can receive a new kidney from a live or deceased donor. Transplant teams must match the blood of a donor with the blood of the recipient. They also perform tissue matching, which helps predict the likelihood of the recipient’s immune system rejecting the donated organ.
Live donor
According to the National Institutes of Health (NIH), kidneys donated from a family member are more likely to match than those donated from a non-family member. Family members or friends willing to donate a kidney must also undergo testing to ensure they are healthy enough to donate.
Deceased donor
Without a live donor, candidates can add their names to the national kidney transplant waiting list. A candidate can add their name only if deemed eligible from a formal transplant evaluation. From the waiting list, they can receive a kidney from a person who recently died and had no known chronic kidney disease.
Patients must undergo regular blood tests during their time on the waitlist. Transplant centers need the most recent blood samples to match available kidneys and determine the likelihood of a rejection episode occurring after transplantation.
Patients on the waiting list report for surgery as soon as a kidney becomes available. Doctors can preserve a kidney from a deceased donor for up to 48 hours.
How long is the wait for a new kidney?
Patients can spend months or years waiting for a new kidney. Although transplant centers typically give preference to those who have been on the waiting list longest, several other factors can affect who receives a kidney, including:
Age: Children with kidney failure receive priority listing. While no upper age limit exists for a transplant, doctors do consider patient fitness and frailty. A frail patient is more likely to have complications after surgery than others.
Where you live: Depending on where a patient lives in the U.S., the rate of kidney transplantation can vary.
Blood type: Patients with certain blood types, especially those with types O and B, wait longer than others. Patients with type A or AB generally have the shortest waiting time.
According to the U.S. Organ Procurement and Transplantation Network, as of March 2023, more than 88,000 people remained on a waiting list for a kidney in the United States.
Are kidney transplants always successful?
A kidney transplant operation typically lasts 3 to 4 hours. Surgeons often transplant the kidney into the lower abdomen without removing either of the original, non-functioning kidneys. Those receiving a kidney from a live donor must undergo surgery at the same time as the donor.
While kidney transplants are considered highly successful procedures, not everyone has success. In fact, the body can sometimes reject the kidney.
When rejection occurs, the immune system — the body’s natural defense against infections and diseases — recognizes the new organ as a foreign tissue. It begins attacking the organ as it would any other foreign agent, such as a bacteria or virus.
What are signs and symptoms of kidney rejection?
There’s no obvious way to tell if your body is rejecting a new kidney. Even in some advanced cases of kidney rejection, you may not feel pain or experience any changes hinting at trouble.
Generally, doctors monitor kidney health with a blood exam. The exam helps calculate a glomerular filtration rate, or eGFR, to determine how well the kidney functions. Those with lower eGFR levels possess higher amounts of the unwanted waste normally filtered by the kidneys in their bloodstream. Sex and age impact eGFR levels, too.
Regular blood tests and regularly seeing your transplant physician, transplant nurse practitioner, or primary care provider (PCP) after a transplant can help catch rejection at its earliest stages.
Reversing a kidney rejection depends on how early the rejection is diagnosed. If a blood exam suggests any signs of kidney dysfunction, you get an ultrasound. This can rule out issues related to the transplant surgery. During surgery, breakdowns may occur in the blood vessels connected to the kidney, or in the ureter carrying urine to the bladder.
An ultrasound can unveil:
Urine flow blocked from the kidney to the bladder
A collection of fluid surrounding the kidney
Irregular blood flow to and from the kidney
If an ultrasound reveals no structural issues, a doctor orders a kidney biopsy. This can help definitively determine whether a rejection occurs.
Medication can help reverse a rejection episode in most cases. Some forms of chronic rejection are more difficult to treat. Kidney transplants affected by chronic rejection may slowly progress to kidney failure.
Do I still need to take medication after a transplant?
Yes. Once you receive a kidney transplant, you need to take transplant medications, generally, for the lifetime of the new kidney. These medications, called immunosuppressants, prevent the body’s immune system from rejecting the kidney.
That said, immunosuppressants work by severely weakening the immune system. They leave patients susceptible to other illnesses. You likely need other medications, which help:
Prevent infections. Anti-viral medications help the body fight viruses its immune system can no longer fight to the best of its ability.
Control blood pressure. Many potent immunosuppressive medications cause blood pressure to spike.
“Never stop taking these medications on your own,” says Dr. Williams. “It’s crucial that patients adhere to the instructions provided by their doctors in the weeks and months following their transplant procedure.”
Doctors can adjust medications in response to side effects, including:
Acne, which is a common side-effect of prednisone. Doctors commonly use this steroid in combination with other drugs.
Weight gain. Patients often experience an increase in appetite and water retention when taking steroids.
Facial hair, either as hair loss (alopecia) or excessive hair growth (hirsutism)
Eye conditions, such as cataracts, which can occur after years of exposure to steroids.
Extra stomach acid
High blood pressure
How will my diet change after a kidney transplant?
After surgery, try to avoid foods that may increase the likelihood of falling ill.
These foods include:
Raw or undercooked meats
Raw fish, sushi, and shellfish
Raw or undercooked eggs
Unpasteurized dairy products (such as yogurt, cheese, or milk)
Remember to always wash vegetables and salads before eating them. Dr. Williams advises patients not to eat grapefruits, or beverages containing grapefruit. The fruit can interfere with medication levels.
“Remember: Having a new kidney gives you the ability to have a less restricted diet,” says. Dr. Williams. “That’s exciting, and it gives you the ability to live a less restricted lifestyle, allowing you to enjoy activities you once enjoyed.”
Do kidney transplant recipients need to stay on immunosuppressants forever?
Immunosuppressants sometimes do more harm than good over a long period of time. They may increase the likelihood of developing:
Cancer. Skin cancer and lymphoma are the two most common cancers that occur post-transplant. During treatment, schedule regular doctor appointments for screenings and skin exams.
Diabetes. The condition occurs post-transplant in about 15% of patients treated with the immunosuppressant tacrolimus in combination with steroids.
The Legorreta Center for Clinical Transplant Tolerance at Mass General uses an innovative treatment to help patients reduce, or even discontinue, medication while ensuring the success of an organ donation.
To perform the treatment, called transplant tolerance, doctors infuse bone marrow or blood stem cells from the kidney donor into the recipient. The bone marrow or stem cells train the recipient’s body to gradually recognize the donated kidney. This helps reduce the body’s dependence on immunosuppressants.
Improvements to kidney transplant care
Mass General Brigham doctors are committed to expanding kidney transplant care to underserved communities. Minority patients without health insurance cannot access many of the resources required to complete the long list of steps needed to undergo a transplant. Many live too far away from transplant centers, and some are predisposed to diabetes and high blood pressure, both of which are significant risk factors for kidney disease.
In March 2023, Mass General launched its Equity in Kidney Transplantation (EqKT) Initiative to address these disparities. The program has already:
Offered multilingual, virtual, and in-person medical care and education
Provided access to transportation and food resources
Collected and analyzed data of social determinants of health throughout each stage of the transplant process
An equitable eGFR
Correcting institutionalized racism can remove further barriers to kidney transplants.
According to Dr. Williams, eGFR rates, originally based on data recorded from white populations in the 1970s, often understate the progression of chronic kidney disease in Black populations. Historically, he says, eGFR equations used a coefficient — or a correction factor — to account for differences found in eGFR rates among Black and white patients. This coefficient disadvantages Black patients by overestimating their kidney performance.
Researchers at Brigham and Women’s Hospital have underscored the disparities created by this coefficient. After evaluating the electronic health records of more than 56,000 patients, they found that removing the coefficient reclassified 1 in 3 African American patients to a more severe stage of kidney disease.
Their findings prompted Brigham and Women’s Hospital to stop using the coefficient in its eGFR equation.
“Making clinical care more equitable and accessible is a priority across all of Mass General Brigham,” says Dr. Williams. “World-class health systems and doctors don’t end their research in the lab, nor does their care end in the clinic. They investigate how unrecognized institutional problems, like structural racism, can have unintended harmful consequences to the goals of providing equitable, high-quality health care to all patients. How they act on it distinguishes them and sets the benchmark for health systems across the country.”
