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Living Kidney Donor Transplant

Living Donors

Most kidneys for transplant are from people who have died and whose families give permission for organ donation. But there aren't enough of these organs for everyone who needs one. Nationally, more than 70,000 patients are on the kidney transplant waiting list, and more are added each year.

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.

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 procedure, called laparoscopic donor nephrectomy, to remove kidneys from living donors. We have performed more than 850 of these procedures, making our program one of the most experienced in the country. The procedure uses tiny incisions and a scope or camera, similar to one used to remove a gall bladder. The procedure has a shorter recovery period and the complication rate is very low. In addition, the quality and function of the transplanted kidneys are excellent.

The procedure will be described in detail by the surgeon prior to surgery. The operation usually takes three hours. Most patients undergoing laparoscopic surgery for kidney donation 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 resides 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.

Special programs for living donor transplants include:

  • Blood Type Incompatible
  • Paired Exchange
  • Positive Crossmatch
  • Waiting List Exchange

Blood Type Incompatible Kidney Transplant

This is a new program that enables patients to receive a kidney from living donors, even though their blood types are incompatible. To receive these kidneys, patients must undergo several treatments before and after the transplant to remove harmful antibodies that can cause organ rejection.

A process called plasmapheresis, which is similar to dialysis, removes these harmful antibodies from the blood. Patients need five to 10 treatments with plasmapheresis before transplant and may require several more after transplant to maintain low antibody levels.

Some patients may have their spleens removed at the time of transplant surgery to lower the number of cells that produce antibodies. The spleen produces blood cells. The spleen, which is the size of a fist and located in the upper left part of the abdomen under the rib cage, can be removed laparoscopically, using tiny incisions and a tiny scope or camera.

Because the harmful antibodies — and in some cases the spleen — are removed, the risk of rejecting the kidney is greatly reduced.

During the first several weeks after transplant, patients are monitored closely with blood tests to make sure that the kidney functions properly.

Positive Crossmatch and Sensitized Patient Kidney Transplant

This program performs kidney transplants in patients who have developed antibodies against their kidney donors — a situation known as "positive crossmatch." The process is similar to that for blood type incompatible kidney transplants.

Patients may receive medications to decrease their antibody levels or they may undergo plasmapharesis treatments to remove the harmful antibodies from their blood.

Plasmapheresis, which is similar to dialysis, is used to remove these harmful antibodies from the blood. Patients require five to 10 treatments with plasmapheresis before transplant and may require several more after transplant to keep their antibody levels down. If antibody levels to their donors are reduced, they can proceed with transplants.

Blood type incompatible kidney transplants and positive crossmatch kidney transplants have been very successful. Success rates are close to those for transplants from compatible living donors and are better than the success rates for deceased donor transplants. This is an excellent option for patients who otherwise are not able to have a living donor kidney transplant.

Transplant Surgery

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.

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.

 

Reviewed by health care specialists at UCSF Medical Center.

Related Information

UCSF Clinics & Centers

Organ Transplant

Kidney Transplant Program
400 Parnassus Ave., Seventh Floor
San Francisco, CA 94143
Phone: (415) 353-1551
Pre-Kidney Fax: (415) 353-8708
Post-Kidney Fax: (415) 353-8381

Pancreas Transplant
400 Parnassus Ave., Seventh Floor
San Francisco, CA 94143
Phone: (415) 353-1551
Pre-Transplant Fax: (415) 353-8708
Post-Transplant Fax: (415) 353-4183

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