Kidney Transplant - Procedures

As kidneys become diseased, they lose their ability to function, a condition called end-stage renal disease (ESRD) or kidney failure. Treatments for kidney failure are hemodialysis, a mechanical process to clean the blood of waste products; peritoneal dialysis, in which toxins are removed by passing chemical solutions through the abdomen; and kidney transplant.

None of these options cures kidney failure. But a transplant offers the best prospects, given that the transplanted kidney functions successfully.

Kidneys for transplant come from a living donor or a deceased (cadaver) donor. When a kidney is transplanted from a living donor, the donor's remaining kidney enlarges to take over the work of two. As with any major operation, there is a chance of complication. But kidney donors have the same life expectancy, general health and kidney function as others. (See Living Donor FAQs.)

Any healthy person can safely donate a kidney. The donor must be in excellent health, well informed about transplantation and able to give informed consent.

Costs for living donor surgery, hospitalization, diagnostic tests and evaluation usually are paid by the recipient's insurance. Travel and living expenses are not covered. Insurance coverage will be discussed during the transplant evaluation.

If you have a potential living donor, he or she will undergo an evaluation and discuss the possibility of organ donation. Tests will be performed to ensure that the donor and recipient are compatible. In some families, several people are compatible donors. In other families, none are suitable.

Since 1999, UCSF has been using a new procedure, called laparoscopic donor nephrectomy, to remove living-donor kidneys. About 850 of these procedures have been performed, making our program one of the most experienced in the country. The procedure, which has a shorter recovery period, involves tiny incisions and a scope or camera, similar to one used to remove a gall bladder. The complication rate of this procedure is very low and the quality and function of transplanted kidneys are excellent.

The procedure will be described in detail by the surgeon prior to surgery. The operation usually takes three hours. Most laparoscopic donor nephrectomy patients require a hospital stay of only two to three days. After discharge from the hospital, the donor is seen for follow-up care in the transplant clinic. If the donor is from outside the San Francisco region, he or she should stay in the area for at least a week after discharge. Donors, who undergo laparoscopic surgery, often return to work within three to four weeks after the procedure.

A cadaveric kidney comes from a deceased donor. The Uniform Anatomical Gift Act allows us to donate organs for transplant when we die and allows our families to provide permission as well. All donors are carefully screened to prevent disease transmission.

If you decide to undergo a cadaveric kidney transplant and you're medically eligible, your name will be placed on a cadaver waiting list. A blood sample for antibody level will be sent monthly to the medical center. The waiting period for a cadaver kidney depends upon the availability of a cadaver donor compatible with your blood type and your antibody level.

When a kidney becomes available, your referring kidney specialist is contacted for approval. The transplant service will verify that you have no recent infections or medical problems that would interfere with a safe transplant. We will assist you in making arrangements for your transplant.

Your surgery may last from two to four hours. During the operation, the kidney is placed in your pelvis rather than the usual kidney location in the back. (Your own kidney will not be removed.) The artery that carries blood to the kidney and the vein that removes blood from it are surgically connected to two blood vessels in the pelvis. The ureter, or tube that carries urine from the kidney to the bladder, is transplanted through an incision in the bladder.

After the operation, you will remain in the recovery room for a few hours and then return to the Kidney Transplant Unit. The surgeon will inform your family when the procedure is over.

You will be encouraged to get out of bed 12 to 24 hours after surgery and walk as much as you can. Nurses will instruct you in taking your medications, explain the side effects and discuss making lifestyle changes.

A cadaver kidney transplant sometimes will be temporarily slow in functioning, a condition called a "sleepy" kidney or acute tubular necrosis (ATN). You may need to undergo dialysis a few times. A "sleepy" kidney usually starts working in two to four weeks.

Most transplant recipients must take medication called immunosuppressants to prevent rejection of the transplanted organ. One of the side effects of these anti-rejection drugs is an increased risk for cancer, particularly skin cancer and lymphoma. You should be closely monitored for these conditions.