Kidney transplantation

What is it?

Kidney transplantation is a surgical procedure in which an individual whose own kidneys have failed (stopped functioning) receives a new kidney (graft kidney) to take over the task of cleansing the blood of waste materials. Graft kidneys may come from donors who are living or dead, related or unrelated to the recipient. Two important requirements for successful transplantation include a careful match between the recipient's and the donor's blood type and tissue type. Often recipients must wait until a suitable donor kidney is found, using dialysis treatments during the waiting period. When a donor kidney is finally found, time is usually short, and the operation must be performed within a few hours.

The operation itself involves an incision in the lower part of the abdomen and placement of the donor kidney there. This location is chosen instead of the location of the individual's original, failed kidneys, because the operation is simpler. Connections of the kidney artery and vein are made to corresponding blood vessels in the abdomen, and the tube that carries the urine (ureter) is connected to the individual's bladder. The operation takes about three to four hours.

The donor of the graft kidney may be a living donor, who most often is a close family member of the recipient such as a parent, child, brother, or sister. There is usually a better match of blood and tissue types with close family members and, as a result, a lower chance of rejection of the graft kidney. The donor and recipient operations are scheduled at the same times, usually in adjacent operating rooms. The left kidney is ordinarily taken as the donor kidney because it has the longer renal vein. The operation typically involves an incision from the donor's back, through the bed of the twelfth rib. Rarely, the operation enters through the donor's abdomen (anterior transperitoneal approach).

Reason for this procedure

Kidney transplantation is one of three common options for the treatment of the kidneys' failure to remove waste materials from the blood stream (chronic renal failure). Kidney transplantation has now become the preferred option in the US. Other options include the broad categories of hemodialysis and peritoneal dialysis.

Prevention of rejection of liver or kidney transplantation

Information	Brand	Generic	Label	Rating
	Deltasone	Prednisone
	Imuran	Azathioprine
	Prograf	Tacrolimus

What might complicate it?

The major risk factors that have an impact on the recipient include age and the presence of diabetes mellitus, arteriosclerotic heart disease, chronic pulmonary disorders, and malignancy. Postoperative complications center around graft rejection and the establishment of renal function. Anti-rejection therapy involves administration of drugs such as corticosteroids, cyclosporine, or azathioprine in various combinations.

Appropriate specialists

Nephrologist, cardiologist, medical oncologist, general surgeon, or renal nutritionist.

Last updated 6 October 2015