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 kidney 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
- 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.
This will include samples for ABO, Human Leukocyte Antigen (HLA) Tissue Typing and Cytotoxic Antibodies.
This test shows your blood type (A, B, AB, O). Your blood type needs to match or be compatible with the blood type of the donor.
HLA Tissue Typing
HLA reveals a set of antigens. Antigens are inherited from each parent. The HLA typing helps the transplant surgeon to find the best match with a potential donor.
This test will show the level of antibodies that have formed against certain antigens. An antibody occurs from being exposed to other tissues or blood. This exposure can come from events such as blood transfusions, delivery of a baby or previous transplants.
If the antibody level is high, it may be more difficult to find a compatible match with a donor, which could extend your time waiting for a transplant. The transplant coordinator will arrange for you to have a sample of blood drawn once a month and sent to the Transplant Center. This is done to monitor the levels of antibodies in your blood and to cross match your blood when a potential donor becomes available. All of these steps improve your chances of having a successful transplant and reduce the risk of possible complications that could arise after surgery.
Waiting for Transplantation
The amount of time you wait for a transplant varies depending upon the blood type, antibody level, medical condition, number of other patients on the waiting list and the availability of donor organs. Some patients have waited only one day; others have waited months to years.
See our kidney pre-transplant PDF for more information on the process.
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.
An open-donor nephrectomy is done through a flank incision either on the left or the right side of the abdomen, just above or 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 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. Laparoscopic-Donor Nephrectomy is the preferred surgical technique at Nebraska Medicine.
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:
- Reinforce your medications
- Potential complications
- When to call the Transplant Office
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:
- Take all medications as instructed
- Have lab work done as scheduled
- Call the transplant coordinator or doctor if there are any symptoms of rejection, infection or any other problem
- Keep regular appointments with your doctor