How to Prepare for a Kidney Transplant

At UPMC, we carefully evaluate potential living donors to reduce your risk of complications when they donate their kidney.

We perform comprehensive medical and psychosocial exams to determine risk for surgery and follow-up needs after surgery.

Steps of Living-Kidney Donation

From the perspective of the patient receiving the kidney, the living-donor transplant process is similar to a traditional kidney transplant (where the kidney comes from a deceased donor.

For kidney donors, the process includes the following steps:

Throughout the living-donation process, donors will interact with a multidisciplinary team of kidney transplant experts, including:

• Dedicated living-donor transplant coordinator
• Transplant social workers
• Dedicated transplant nurse coordinators
• Nutritionists
• Transplant nephrologists
• Transplant surgeons
• Pharmacy transplant credit analyst

This team will determine if you are suitable for living-donation.

Partnering Through Organ Donation

If cleared to donate an organ, donors will be assigned an independent living-donor advocate to act on their behalf.

The living-donor advocate helps to ensure the donor is fully aware of what it means to be a living donor and understand the risks of the transplant surgery.

The living-donor advocate will voice any concerns of the donor to the multidisciplinary transplant team and will determine that the donor’s decision is fully informed.

The standard surgical procedure to remove a kidney is called a laparoscopic donor nephrectomy. Laparoscopic surgery minimizes surgical incisions and reduces recovery time, and Mount Sinai was among the first in the nation to offer laparoscopic surgery for living donations. The decision of which kidney to remove is based on factors including each kidney’s size.

After general anesthesia is administered, the surgeon will make two-four small incisions through which he or she will disconnect the necessary blood vessels and ducts. A slightly larger incision will also be made through which the kidney will be removed. All incision sites will then be stitched closed. Patients are also given an IV through which fluids and medications can be administered. A urinary tube will also be inserted into the bladder following surgery to measure urine output.

The scars from a laparoscopic donor nephrectomy are minimal, consisting of two-four small scars where the laparoscopic ports were inserted, plus a scar for the incision through which the kidney was removed.

Recovery from Living Kidney Donation

The process of recovering from living kidney donor surgery usually follows these steps.

In the hospital: The first day after surgery you could be sore and slightly groggy. You may experience pain and some nausea as you are switched from IV to oral pain medication. Before leaving the hospital, you will be encouraged to walk a little. Donors can expect to remain in the hospital for one-two days.

At home: By the time you go home from the hospital you should start feeling yourself again. Following discharge, you will be given a prescription for oral pain medicine to take as needed. While you will be feeling noticeably better, you should expect to be moderately fatigued for up to several weeks. Once you return home, if you develop a fever or have drainage from your incision you should call the transplant office and speak to your nurse or doctor. You should shower daily, wash your incision with soap and water, and pat dry. You should eat a normal, healthy, well-rounded diet to improve healing.

For the first four weeks after surgery, you must not lift greater than 20 lbs. Otherwise, you are encouraged to slowly resume normal activity at your own pace, making sure that you walk daily and stay active. Most donors will be out of work for two-four weeks but not feel 100 percent normal for up to three-four months.

Post-surgery follow-ups: The living donor team will follow you closely as you recuperate. You will be seen two weeks after discharge to assess your condition and check your blood tests, then again at six weeks, six months, one year, and annually for two-five years. If you feel ill and need additional follow-up at any time, you should not hesitate to contact the transplant center.

Throughout the donation process, it is also important to keep your primary care physician aware of your progress and see him or her annually for check-ups. You should provide the donor team with your primary care physician’s contact information so that we may keep him or her fully informed of your care.

A Long-Term Relationship with Mount Sinai

At Mount Sinai, living donation doesn’t end with the donation. Donors can expect a long-term relationship with the Zweig Family Center, the RMTI, and Mount Sinai. This will include post-surgery follow-ups for the first year after the donation, as well as ready access to the RMTI team thereafter should any other concerns arise.

Long-term complications from living kidney donation are rare. Individuals only need one kidney to maintain optimal health; after surgery, the remaining kidney tends to increase in size to compensate for the loss of the other kidney. Additionally, living donors are screened in advance to make sure they are not at elevated risk for kidney disease in the future. This too helps ensure that that long-term complications are unlikely.

Even if feeling healthy, donors are encouraged to keep in touch and take advantage of donor wellness programs run by the Zweig Family Center.

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Preparation is key to a smooth recovery

If you have kidney disease or kidney failure, you may be facing the tough decision of going on dialysis or getting a kidney transplant.

Both procedures have pros and cons, but in most cases, a kidney transplant is the best option.

“Dialysis removes toxins from the body like the kidneys would,” said Geisinger nephrologist Maria Camila Bermudez, MD. “But, you need to get dialysis periodically to stay healthy. Kidney transplants can last the rest of your life if you take care of them. Many people feel that kidney transplants give them more freedom and improved quality of life.”

Kidney transplants are life-saving procedures, but there is a shortage of donors. Every day, 12 people die waiting for a kidney. Fewer than 20 percent of people who need kidneys receive a transplant every year.

Why transplants are important
Your kidneys filter toxins out of your blood and help regulate the amount of water in your body. Your kidneys are one of the most important organs in the body.

Toxic chemicals like mercury and conditions like diabetes can damage your kidneys. This damage causes loss of kidney function and eventually leads to kidney failure.

“If you have kidney failure, you need to get a transplant or dialysis,” said Dr. Bermudez. “Without one of these procedures, toxins will build up in the body, eventually causing death. Unfortunately, you can’t stay on dialysis forever—it only does 10 percent of the work of a functioning kidney. At some point you’ll need a transplant.”

If you’re getting a kidney transplant, here are some things you should know.

Before the transplant
Once your doctor has diagnosed you with kidney disease or kidney failure, they will either recommend that you go on dialysis or get a transplant based on your kidney function. When deciding which is right for you, your doctor will take into account whether you are healthy enough for a transplant procedure.

If you and your doctor decide a transplant is the best option, you’ll need to find a kidney donor.

The first step is to find a kidney match. Because of your individual blood type and antibodies, you can only accept kidney donations from certain people. Your doctor will test other people like friends and family to help find a kidney that is a match for you.

Because people can live with only one kidney, your kidney may either come from a living donor or a cadaver.

Preparing for surgery
The best way to prepare for a kidney transplant is to make healthy habit changes.

Start exercising regularly if you aren’t already. Start eating a healthy diet—this will help both before and after your procedure.

“If you’re going in for a kidney transplant, it’s important to quit smoking,” said Dr. Bermudez. “Smoking can increase your risk of complications. It can also cause your wounds to heal more slowly. Try to quit smoking at least four weeks before surgery.”

It’s important to have a plan for what happens after your surgery. You won’t be able to drive, bend over or lift anything after the surgery. Talk to friends and family members who can drive you and help you around the house.

Bring warm clothes, a small pillow, books and music to keep you comfortable during your hospital stay.

Finally, write up a list of questions for your doctor. If you bring the list with you when you go to see your doctor, there’s less of a chance you’ll forget to ask something.

After the surgery
After the surgery, you’ll have to stay at the hospital until the doctors release you. Normally, you’ll spend between five and 10 days in the hospital.

Your doctors will give you medicine to prevent your body from rejecting the new kidney. Take these medications as directed to avoid complications.

It’s important to take good care of your new kidney to avoid future kidney failure and complications.

Following your transplant, you should agree on an appropriate exercise routine and diet with your doctor. Working out may help make recovery easier and faster. Eating a healthy diet can help you feel good during recovery. These habits can help ensure that your new kidney lasts as long as possible.

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The health and safety of our patients and teammates is our top priority. We are keeping a close eye on this situation and reinforcing the extensive infection control practices already in place to protect them. Click here to find videos and additional resources.

Getting ready for a kidney transplant? Transplant is a gift of life. You definitely want to be prepared for when the time arrives. Both late stage chronic kidney disease (CKD) patients and dialysis patients may be eligible to receive a new kidney. For those who do receive a transplant, being as healthy as possible is important. One issue, malnutrition, can lead to poor wound healing and higher chance of infection after surgery. Therefore, getting ready starts with diet and lifestyle changes prior to transplant. Your goal is to keep your body as healthy as possible to insure you do your best after transplant and during recovery.

Diet Tips for Transplant Preparation

Learning about what you can do now will help you to be ready for a kidney transplant. The tips below provide food for thought. Follow up with your transplant team for more information on your individual goals.

Healthy Body Weight

It is common for transplant centers to have certain requirements for a person to get a kidney transplant. Body weight, measured as body mass index (BMI) is one requirement. Therefore, care must be taken to manage a healthy body weight.

For patients who are overweight, gradual, safe weight loss is encouraged through eating well balanced meals. These meals may consist of lean meats such as chicken or turkey, whole grains and fresh or frozen vegetables.

Learn about healthy ways to prepare meals. This can help to decrease the calories at a meal. Such methods include:

• trimming the visible fat off meats and removing the skin from poultry
• baking, broiling or grilling to reduce fat.
• limit the use of butter, lard or shortening in cooking.

In addition, increase activity as you are able to help burn calories. Decreasing sodium (salt) intake and limiting fluids during the day may help with fluid balance.

Appetites may decrease due to gastrointestinal (GI) issues, tiredness or side effects of medicines. For those patients who are underweight, focus on small frequent high calorie meals and snacks during the day. This may assist in increasing calorie intake. The use of nutrition supplements may also help make up for the calories and protein missed during the day.

Healthy Bones and Adequate Protein Levels

Healthy bone maintenance is incredibly important. Reduced calcium absorption may be due to hyperparathyroidism, abnormal vitamin D metabolism or some medications. Paying close attention to calcium and phosphorus levels can help to ensure the protection of healthy bone.

Dialysis patients following a low phosphorus diet and taking prescribed medications can improve phosphorus control. Some high phosphorus foods that may be limited include some dairy products, nuts, seeds, dried beans and processed foods with phosphate additives.

As for protein, it is an important building block of bones, skin, blood, and muscles. Patients on dialysis need high quality proteins in their diet. Examples include meat, fish, eggs and soy products. Protein is needed to replace the protein that is lost during the dialysis process. CKD patients not on dialysis may need a lower protein diet to decrease protein waste build up in the blood.

Blood Fats and Blood Pressure Control

Elevated levels of total cholesterol, low density lipoproteins (LDL) and triglycerides increase the risk of heart problems. Some ways to keep blood cholesterol controlled for good heart health include the following:

• a diet low in sodium
• saturated fat and dietary cholesterol
• adequate amounts of dietary fiber.

Diet After Transplant

After receiving a kidney transplant your diet will change. With a working kidney a normal potassium and phosphorus diet are possible. Watching fat and carbohydrate intake may become more important. Your transplant team will work with you to provide education on your transplant diet.

References

Additional Kidney Diet Resources

Visit DaVita.com and explore these diet and nutrition resources:

• DaVita Diet Helper online meal planner and tracker
• DaVita Kidney-Friendly recipes
• Today’s Kidney Diet cookbooks
• Diet and nutrition articles
• Kidney Diet and Nutrition Hub
• Kidney Smart® Classes taught by kidney experts in your area

This article is for informational purposes only and is not a substitute for medical advice or treatment. Consult your physician and dietitian regarding your specific diagnosis, treatment, diet and health questions.

Stephanie Suhai, MS, RD

Stephanie Suhai, MS, RD has been a dietitian for 10 years, working in acute care, sub-acute rehab, and long term care and now works in dialysis with both hemodialysis and peritoneal dialysis patients. She holds a passion for clinical nutrition research, counseling and education. In her free time she enjoys traveling, reading, staying active and spending time with her family.

Once your physician determines you are a candidate for transplant, and you’ve determined you want to pursue it, there are some key steps to keep in mind as you go through the process. Here’s a look at the path to receiving a kidney transplant, and how to make it a successful treatment option when you have end stage renal disease (ESRD).

1. Finding an ideal kidney match

There are two types of kidney donors:

• Living donor: Elects to donate one of their kidneys and undergo surgery for its removal.
• Deceased donor: Allowed usable organs to be donated at their death.

Tests are needed to determine if the donor and recipient are a good match to help increase the chances of a successful transplant. There are three tests: blood type matching, tissue matching and crossmatching.

• Blood type matching: Matches your blood type to the potential donor’s blood type.
• Tissue matching: Measures and defines certain proteins, called antigens, present in the patient and potential donor’s blood and tissue proteins.
• Crossmatching: Performed by mixing a small amount of the patient’s and potential donor’s cells.

If you have a potential living donor and the transplant team has determined that person is a good match, they will also undergo a thorough medical evaluation at the transplant center. If things go well, you and your living donor will be scheduled for the transplant surgery.

If you do not have a living donor, you will be placed on the waiting list for a cadaver organ.

2. Getting on the kidney transplant waitlist

First, your transplant center will determine if your insurance covers surgery and post-surgery medical needs. Then, if you do not have a living donor, your transplant center will place you on their waiting list for a kidney and register you for the national transplant waiting list at United Network of Organ Sharing (UNOS). Here are some important things to know when you’re on the waitlist:

• You will be required to list several phone numbers—home, work, family, friends and neighbors—where you can be reached if a kidney becomes available.
• The average wait time for a kidney transplant is more than three years.
• When you have ESRD, you must undergo dialysis until a kidney is found.
• When a kidney becomes available, the nearest transplant center is notified and it is logged into the UNOS database.
• Once you are called, you only have a few hours to get to the transplant center. Although a call is a good indication, it is not a guarantee of a kidney.
• Transplant surgery often takes place on very short notice.
• Living a healthy lifestyle and following your kidney doctor’s (nephrologist’s) orders can help you stay on the donor waitlist and be in the best condition possible for surgery.

Talk with your renal social worker about the possibility of enlisting with multiple transplant centers as well.

3. Going through kidney transplant surgery

Different techniques for kidney transplant surgery have been developed over the years. Typically, a large incision is made into the recipient patient’s side. Advances in surgical tools and techniques have allowed surgeons to make as small an incision as possible. Your transplant surgeon will discuss the procedure with you, their choice of technique and answer any questions you have.

Depending on your condition, your surgeon may opt to remove the damaged kidney(s) or leave them. After the surgery, you will be hospitalized for several days and closely monitored for complications.

Some newly transplanted kidneys begin working right away. Others may start working after a couple of days. If your new kidney isn’t working right away you’ll receive dialysis until it does. You will remain hospitalized until your doctors are satisfied the new kidney is functioning and you are healthy enough to be released. Your living donor can be discharged from the hospital after a few days.

4. Monitoring your kidney after transplant surgery

Initially, your transplant doctor and nephrologists will require many follow-up visits and tests for a couple of months after the transplant. They want to make sure your new kidney is healthy. Your doctors will also look for signs of complications such as:

• Infection
• Bleeding
• Narrowing of the artery, also called kidney stenosis
• Blood clots: clots in the artery or vein could prevent circulation and cause the kidney to fail
• Kidney rejection
• Weight gain
• High blood pressure
• Cancer: use of immunosuppressant medication may leave you vulnerable to disease

You will remain under the care of your nephrologist for routine visits.

5. Caring for your kidney transplant

When you get a new kidney, it is critical to maintain healthy habits so your new kidney will function properly and give you years of use.

Part of the transplant aftercare is taking required medications. Your doctor will prescribe immunosuppressants, which you will need to take for as long as you have your new kidney. Any pre-existing health conditions you experienced before the transplant will need to be managed as well, especially conditions that contributed to your initial kidney damage such as diabetes or high blood pressure.

By keeping yourself healthy and following your doctors’ recommendations, you may set yourself up for a successful kidney transplantation. Of course, there are no guarantees.

Know someone who would like to donate a kidney? Visit the National Kidney Registry to start the process.

A transplant evaluation is a big step on the kidney transplant journey. This evaluation is a set of medical tests and meetings with individuals at the transplant center that check to see if kidney transplant is a safe and helpful treatment option.

Here is what to expect from the kidney transplant evaluation process.

Schedule the evaluation

After the transplant center receives your referral from a care provider, they will contact you, on average, within 30 to 60 days. If you do not hear from them after that time, call the center to make an appointment.

Prepare for the evaluation

The transplant center may need to collect some information before your appointment, which could include:

• Past medical history
• A list of medications
• X-rays
• Recent lab results

Ask your dialysis social worker and doctor to help you gather this information. Also, bring a family member to the appointment to help write down notes.

What to bring for the evaluation

Here are some items to bring that can help you feel prepared on the day of the evaluation:

• A folder with the information requested by the transplant center plus important questions to ask at the evaluation
• Comfortable clothes and shoes
• Glasses and/or hearing aids
• Pen or pencil and notepad to take notes
• Kidney-friendly snacks and/or lunch

Bring a family member or friend for support. If you have a living donor in mind, let the transplant center know in advance of the evaluation appointment.

What to expect at the evaluation

The transplant evaluation goes a bit differently at every transplant center. Some centers will do your evaluation all in one long day. Other centers will do evaluation over multiple days. Either way, they usually have similar steps :

1. Meet the transplant team—which often includes a nephrologist, surgeon, transplant coordinator, social worker, dietitian, financial counselor and pharmacist.

2. Have blood tests taken

3. A medical exam — which may include a chest X-ray, CT scan, EKG, echocardiogram, colonoscopy, dental check and stress test (done on an exercise bike or treadmill).

What happens after the evaluation

Once your evaluation is complete, the transplant center team will get together to discuss your overall results. They will determine if a kidney transplant is safe for you. The next step depends on if you have a living donor or need to join the waiting list for a kidney from a deceased donor. If you are seeking a living donation, you can learn more on how to talk about this subject .

If you are looking to join the waiting list for a deceased donor kidney, the transplant center will usually come back with one of three possible results.

1. The transplant center will add you to the waiting list. Here is information to help you remain healthy while waiting for a kidney.

2. The transplant center will not add you to the waiting list. This does not necessarily mean it is the end of your journey. You may have options, such as:

• Ask your transplant center if you might be a candidate for living donation. Some centers have different rules for living versus deceased donation.
• Explore other transplant centers because they may have different rules. Talk to your social worker for referral to a new center.

3. The transplant center is not ready to add you to the list but has confirmed that you might be a candidate. There could be several reasons for this delay, such as needing more tests, needing to lose weight, needing a medical condition to get better, etc. Work closely with your transplant center and nephrologist to understand what you need to do to get on the list

Waiting for a deceased donor kidney transplant can take an average of three years, or longer. At Memorial Transplant Institute, our dedicated transplant specialists understand how stressful this waiting period can be. We stay in close contact with patients and provide the support you need to ensure you’re ready for kidney transplant surgery at a moment’s notice.

Before Kidney Transplant Surgery: How to Prepare

We add all eligible patients to the United Network for Organ Sharing (UNOS) kidney transplant list, which matches organs from deceased donors with individuals based on the severity of their condition. Because there are more people in need of a kidney than available organs, most people wait at least three years for a deceased donor kidney transplant.

Our team is committed to working with patients to ensure you’re ready for transplantation when a donor organ becomes available. We:

• Tell you what to expect: Someone waiting for a kidney could receive a call that an organ is available at any time — day or night, even on a weekend or holiday. Because of the timely nature of transplantation, once a donor organ becomes available, you’ll be asked to come to the hospital immediately. As soon as you’re eligible for the national kidney transplant list, our transplant coordinator will start preparing you for what to expect when you receive the organ offer call.
• Help you keep track of medical tests: There’s no time to redo medical tests once an organ becomes available, so up-to-date medical tests are essential for transplantation. Certain tests need to be repeated yearly (or more often). We’ll help remind you of testing requirements and give you tips to help you keep track of testing dates.
• Provide regular follow-up care: If you’re waiting to be matched to a deceased donor kidney, we’ll see you every six months or sooner to monitor your health. During these visits, our team will also ask about the support network available to you and ensure that a plan for who will take care of you after kidney transplant surgery is still in place.
• Support you at every point: Our caring professionals will point you to resources that can help you cope with any anxiety or stress you may feel during the waiting process. We’ll make sure you know that you can always reach out to us with any questions or concerns you have.

Your life after kidney transplantation will change in many ways, from the kind of medical care you need to your energy levels and so much more. Start preparing yourself for what’s to come by learning about our resources for patients and families. You can also read our kidney transplant caregiver tips.

Learn More About Adult Kidney Transplant

We are always just a phone call away. You can learn more about our customized adult kidney transplant care by calling us anytime at 954-265-7450.

Learn More About Pediatric Kidney Transplant

If you believe your child may benefit from a kidney transplant, we want to hear from you. You can learn more about our personalized pediatric kidney transplant care by calling us anytime at 954-265-7450.

What happens during the kidney transplant procedure?

Kidney transplantation involves placing a healthy kidney into the body, where it can perform all of the functions that a failing kidney cannot.

The new kidney is placed on the lower right or left side of your abdomen where it is surgically connected to nearby blood vessels. Placing the kidney in this position allows it to be easily connected to blood vessels and the bladder. The vein and artery of your new kidney are attached to your vein and artery. The new kidney’s ureter is attached to your bladder to allow urine to pass out of your body.

What happens to my old kidneys?

In most cases, the diseased kidneys are not removed. There are three conditions that might require your diseased kidneys to be removed:

• Repeated infection that could spread to the transplanted kidney
• Uncontrollable hypertension caused by your original kidneys
• Backup of urine into your kidneys (a condition called reflux)

Last reviewed by a Cleveland Clinic medical professional on 03/20/2019.

References

• National Kidney and Urologic Diseases Information Clearinghouse. Kidney Transplant. Accessed 3/26/2019.
• American Society of Transplantation. Getting a New Kidney: Facts about Kidney Transplants. Accessed 3/26/2019.

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About

The health and safety of our patients and teammates is our top priority. We are keeping a close eye on this situation and reinforcing the extensive infection control practices already in place to protect them. Click here to find videos and additional resources.

Kidney transplantation is often considered as a treatment option by people with chronic kidney disease (CKD) and those on dialysis. Referrals for kidney transplant can be made by your physician, a social worker or by self-referral, once glomerular filtration rate (GFR) is

Michele Tilton, RDN

Michele has been a registered dietitian for over 25 years, and has spent the past 7 years in renal nutrition. She loves being in nature, gardening, walking on trails in Central California and visiting Yosemite National Park with her girls. She enjoys cooking for family and friends and finding new recipes to try.

Comments

I’m on the list. It’s been 2 years I still have years to go. I’m praying on a kidney donor.

Very good information. Thank you! Husband is on 3 list for a transplant. He has been waiting 3 yrs. He caught IGA and HSP while fighting war in Iraq back in 2005. Kidneys completely failed in March of 2017. At that time he was placed on dialysis.

Davita is the best place for people on dialysis.

Thank you for all your information and advice.

In the U.S., an estimated 14 percent of the population has chronic kidney disease, and roughly 661,000 Americans have kidney failure. Of these, 468,000 people are on kidney dialysis, and almost 200,000 live with a functioning kidney transplant.

MedlinePlus and the National Institute of Diabetes and Digestive and Kidney Diseases have helpful information about how kidney transplants and other options can help.

What are kidneys?

Your kidneys are two bean-shaped organs that filter out waste and extra water, make hormones, and do other important things to keep you healthy. They are located on either side of your spine and are each about the size of your fist.

What causes kidney failure?

Diabetes and high blood pressure are the main causes of chronic kidney disease, which is the gradual loss of kidney function. Other conditions that affect the kidneys include autoimmune diseases like lupus and inherited diseases like polycystic kidney disease.

Some people live with kidney disease for years, others quickly progress to kidney failure. Kidney failure means that your kidneys have lost most of their ability to function–less than 15 percent of normal kidney function.

Medication and other methods of managing kidney disease help some people maintain kidney function for years. Others progress quickly to kidney failure.

Dialysis and kidney transplants are two treatments used to replace failing kidneys. Dialysis takes the place of your kidneys by helping remove waste and water from your blood, but doesn’t fully replace everything your kidneys normally do.

Can a transplant help?

When your kidneys have failed, a transplant may also be a good option. Compared to dialysis, a working transplanted kidney does a better job of filtering waste, replacing your failed kidneys, and keeping you healthy.

However, a kidney transplant isn’t for everyone. Anyone interested in a kidney transplant should be evaluated by a transplant center, as some people may not be healthy enough for transplant surgery.

While a transplant is a good treatment for kidney failure, it’s not a cure. You need to take medicines daily so your body doesn’t reject the new kidney. You also need to see your health care professional regularly.

Getting a transplant

Your health care professional will refer you to a transplant center for tests to see if you’re healthy enough to receive a transplant. Living donors, such as family or friends, need to be tested to make sure they’re healthy enough to donate a kidney.

If you have a living donor, don’t worry about being a perfect “match.” Today, innovations such as kidney exchanges allow transplant surgeons to get around incompatibilities and make many living donor transplants possible.

If you don’t have a living donor, you’ll be placed on a waiting list to receive a kidney. You’ll have regular blood tests while you wait for a kidney. The center must have a recent sample of your blood to match with any kidney that becomes available. As soon as a kidney is available, you must go to the hospital to have your transplant. Donated organs need to be used in a specific amount of time or they may not be usable.

During surgery

Surgery usually takes three to four hours. The damaged kidneys are not usually removed.

If a family member or friend is donating the kidney, you’ll schedule the surgery when it’s best for you, your donor, and your surgeon. One surgeon will remove the kidney from the donor, while another prepares you to receive the donated kidney.

After surgery

Many people report feeling better right after having transplant surgery. For others, it takes a few days for the new kidney to start working.

You will probably need to stay in the hospital for several days to recover from surgery–longer if you have any problems. You’ll have regular follow-up visits after leaving the hospital.

If you have a living donor, the donor will probably also stay in the hospital for a couple of days, although probably less time than you will.

Transplant rejection

Transplant rejection often begins before you feel any symptoms. Rejection occurs when the immune system attacks the “foreign” transplanted kidney.

The routine blood tests that you have at the transplant center will reveal early signs of rejection. You may develop high blood pressure or notice swelling because your kidney isn’t getting rid of extra salt and fluid in your body.

If you think you may have transplant rejection, contact your health care professional immediately. Rejection can often be treated, but only if it is detected early. Your health care professional will treat early signs of rejection by adjusting your medicines to help keep your body from rejecting your new kidney. Rejection does not necessarily mean you will lose your transplant.

Additionally, when you’re taking anti-rejection medicines, you’re at a greater risk for infection.

Anti-rejection medicines can dull symptoms of problems such as infection. Call your transplant center right away if you aren’t feeling well or have:

• a fever of more than 100 degrees
• drainage from your surgical scar
• burning when you pass urine
• a cold or cough that won’t go away

Nadeen Khoury, M.D. was a special contributor to this blog post. Dr. Khoury is a renal transplant fellow at Mayo Clinic in Rochester, Minnesota. Her interests include kidney transplant in the elderly and pregnancy after kidney transplant.

One hot topic in the world of transplant has been what the appropriate cut off age should be for patients in need of a transplant. Across the globe, age criteria have been loosely defined. The American Society of Transplantation’s guidelines state “There should be no absolute upper age limit for excluding patients whose overall health and life situation suggest that transplantation will be beneficial.” This topic continues to be examined as the number of elderly individuals in our society has exponentially increased.

Trends in the national kidney waiting list demonstrate the dynamic of an aging population and their need for transplant due to End Stage Renal Disease (ESRD).

• In 2005, 14.5% of listed patients were over age 65
• In 2015, 22% of listed patients were over age 65

The prevalence of ESRD patients on dialysis is increasing among older age groups, as well. In fact, 44.5% of patients with ESRD receiving maintenance dialysis are 65 and older.

Based on this, it’s not surprising to learn there was a 325% increase in deceased donor transplants performed on patients 65 and older between 1997 and 2014, and a 380% increase in living donor transplants during the same period, according to the United States Renal Data Systems Annual Data Report.

If you are age 65 or older and in need of a kidney transplant, or a caregiver of someone who is, here are three key factors to keep in mind as you begin on your journey to transplantation.

1. Thorough evaluation is imperative for determining whether or not you are well-suited for transplant. One key aspect of transplant evaluation in patients age 65 and older is analysis of frailty. Frailty is typically measured by using assessment tools that look at the ability to complete activities of daily living, risk of developing bed sores, and likelihood of falling. Often patients who have frailty pre-transplant are more likely to experience surgical complications, delayed graft function, a longer hospital stay as well as discharge to a skilled nursing facility for further recovery. Do what you can to maintain a level of strength pre-transplant in order to reduce your risk of these complications.
2. The best results for kidney transplant in patients 65 and older are when the kidney is from a living donor. These kidneys are more likely to function immediately and provide better outcomes. When living organ donation is not an option, your transplant provider will look at deceased kidney transplant as an alternative.
3. Interestingly, older recipient age is associated with lower risk of rejection because the immune system weakens with age. Each transplant center has its own protocol for immunosuppression in the elderly. At Mayo Clinic, immunosuppressant medications are tailored to minimize the risk of infection.

If you’re currently awaiting a transplant, has age been a factor in your care plan? If so, how?

HELPFUL LINKS

• Learn about living donation.
• Learn more about kidney transplant at Mayo Clinic.
• Explore Mayo’s Transplant Center.
• Request an appointment.