Transplant Process

Being diagnosed with end-stage renal (kidney) disease (ESRD) can be a confusing and frightening time. We understand that you and your family will have questions. That is why we have a designated transplant team member who is available to talk with you about your disease and which options are best suited to treat your disease. In addition, our team of doctors, nurses, technicians, dietitians, social workers and many others are available to provide you with care and support throughout the transplant process, during your hospital stay and even after you return home.

The following pages will help to explain the transplant process, along with the benefits, risks and various procedures involved with liver transplantation.

Kidney Pre-Transplant Evaluations

To be considered as a candidate for kidney transplantation, you will first undergo a thorough transplant evaluation. During this process, the transplant physicians will be looking for medical and/or emotional conditions that would affect the chances for a successful transplant. The series of tests may include:

  • Blood tests
  • Heart tests
  • Ultrasound
  • Dental exam
  • Complete physical exam

Upon completion of your evaluation, the multidisciplinary transplant team will carefully review all the information from the evaluation and give their recommendation of the best treatment option for you. You will then be contacted by a transplant coordinator to discuss the plan of care.

The video links below link to the video address attached to the links in this document.

View Pre-Transplant Evaluation Videos

The Operation

A kidney transplant is performed by placing the kidney on the right or left side of the lower abdomen. An incision is made to implant the new kidney, attach it to the necessary blood supply and to the bladder for urine drainage. Generally, the native kidneys are left in place; however, exceptions may be made in the event of infection, the potential for infection, the presence of cancer and, in some cases, if a patient has very large kidneys as seen with patients who have polycystic kidney disease.

Other surgical options include:

  • Open-Donor Nephrectomy
    An open-donor nephrectomy is done through a flank incision either on the left or the right side of the abdomen, just above or just below the twelfth rib. This type of donor nephrectomy is considered the standard or traditional method of removing a kidney and can be fairly painful. Average length of stay in the hospital is four to five days. Return to work after discharge can be four to six weeks.

  • Laparoscopic-Donor Nephrectomy
    Laparoscopic-donor nephrectomy is a procedure in which the kidney is removed from the donor through several small (approximately one-inch) incisions. The operation is performed with the aid of a camera, which is inserted through one of the small incisions. Pencil-thin instruments are inserted through the other incisions. At the end of the procedure, the kidney is removed through a five- to seven-inch incision that extends slightly above and slightly below the belly button.

    The potential benefits of removing the kidney laparoscopically (instead of the traditional "open" procedure) include less post-operative pain, a shorter hospital stay and overall quicker recovery time. The average length of stay after laparoscopic donor nephrectomy is about three days and most donors are ready to return to work in four to six weeks. A donor whose work involves heavy lifting is still required to recover for six weeks before returning to full duty. However, many times employers will allow the donors to return to "light duty" until their six-week recovery is completed.

After the Operation

The new kidney should start to work soon after the surgery, but it may be necessary to have dialysis in our inpatient dialysis facility until it does begin to work. You should be able to walk around and start eating a normal diet within a few days after the surgery. During this time, the staff closely monitors your progress with the appropriate tests to see how the new kidney is working.

After your surgery, the transplant coordinator and doctors will instruct you on the following:

  • How to take your medications
  • Warning signs to look for
  • How to read blood tests to watch for early signs of any problems
  • When to call the Transplant Office

Immunosuppressive (Anti-rejection) Medications

Both before and after the transplant surgery, you are given immunosuppressive (anti-rejection) medications. These medications must be taken as long as you have the transplanted kidney. To determine a safe level of these drugs, your blood will be tested and the medication levels will be watched very closely by the transplant team. It is common for the transplant team to make frequent changes in medication doses after transplant to keep the anti-rejection medications in a safe range and yet still able to prevent rejection.

Some problems occur as a result of the side effects of the needed medications. The most common side effect is the lowering of the ability to fight infection. The transplant surgeon and coordinator will discuss other potential problems that include signs and symptoms of rejection and infection.

Potential Complications

All treatments for kidney disease have special problems. Transplantation is no different. As a transplant patient, you need to be aware of the possibility of rejection and infection.

Rejection occurs when the body fights the donor's kidney. This happens because the new kidney is a foreign tissue. Rejection is the most common reason for transplant failure. There are three types of rejection:

  • Hyper-Acute Rejection - This type is very rare, but it can occur minutes or hours after surgery. This isn't treatable. If it happens, the kidney must be removed and dialysis must be resumed until another kidney is available.
  • Acute Rejection - This can occur anytime, but it is most common in the first year after transplant. This type of rejection is usually reversible with anti-rejection medications.
  • Chronic Rejection - This occurs slowly and over a long period of time. There is usually no treatment. The kidney's function may decrease to the point that dialysis is required. If this occurs, the patient may decide to try another transplant. Some patients have had two or more transplants.

The extraordinary care that you received while hospitalized at Nebraska Medicine does not end at the time of discharge. The kidney team continues to follow and monitor your progress. To answer any questions after your transplant, our team is available to you, your family members and your local physician.

You play a very important part in making your transplant a success. There are four basic patient responsibilities after transplant:

  1. Take all medications as instructed
  2. Have lab work done as scheduled
  3. Call the transplant coordinator or doctor if there are any symptoms of rejection, infection or any other problem
  4. Keep regular appointments with your doctor

Patient Education

The video links below link to the video address attached to the links in this document.

View Post-Transplant Care Videos

Refer a Patient