If you or someone you love needs a kidney transplant, understanding the following steps will help.

Pre-Transplant Evaluation
Although you have discussed transplantation with your doctor and decided you may need a transplant, your doctor may refer you to a transplant program.  Each patient referred for a transplant undergoes an evaluation including various physical examinations, diagnostic tests and educational meetings, usually performed on an outpatient basis.

To be considered for a kidney transplant, you must have a diagnosis of end-stage renal disease without any conditions that would exclude you from getting a transplant.  It is not necessary to be on dialysis prior to transplant.  Pre-dialysis candidates should have a GFR of 20 to be placed on the transplant waiting list.

Patient Selection Process
If you are approved as a candidate for transplantation and reimbursement for the transplant has been cleared with your insurer, you will be placed on a waiting list and registered with the United Networks for Organ Sharing (UNOS), the national organ-donor system.

Kidney Transplant
A kidney transplant is surgery to replace your own diseased kidneys with a healthy (donor) kidney.

There are two types of donors:

• Living donors. A living donor may be a family member, a friend, a coworker, or any person who is willing to give a kidney to someone in need.  A person only needs one healthy kidney to live.
• Cadaver donors.  A cadaver donor is someone who has recently died.  Most donor kidneys come from the source.

You will need to have tests to make sure the donor kidney matches your tissue type and blood type.  This helps reduce the chances that your body will reject the new kidney.  You will also be evaluated to make sure that you do not have significant heart or lung disease or other diseases, such as cancer, which might decrease your life span.

Kidney transplant surgery takes about 3 hours.  During surgery, the donor kidney will be placed in your lower abdomen, blood vessels from the donor kidney will be connected to arteries and veins in your body, and the ureter from the donor kidney will be connected to your bladder.  Blood is then able to flow through the new kidney, and the kidney will begin to filter and remove wastes and to produce urine.

The new kidney usually begins to function right away.  In most cases, diseased or damaged kidneys are not removed unless you have a severe infection of the kidney (pyelonephritis), kidney cancer, nephrotic syndrome, or extremely large polycystic kidneys.

What to expect after surgery
You will have to stay in the hospital for 7 to 10 days after you receive your new kidney.  In some cases, it may take time for your new kidney to produce urine to produce urine.  So you may have to receive dialysis and take medicines, such as diuretics, that help your new kidney get rid of excess water and salt from your body.

After the surgery you will have to take medicines to suppress your immune system.  These medicines are used to help keep your body from rejecting your new kidney.  You will need to take these medicines for the rest of your life.

During the first weeks to months after your surgery, your body may try to reject your new kidney.  This is called acute rejection and occurs in 25% to 55% of people after transplant.  Most of the time, acute rejection can be treated with immunosuppressive medicines.

Chronic rejection is a process of gradual, progressive loss of kidney function and can occur many months to several years after your surgery.  Experts don’t fully understand what causes chronic rejection.  There is no treatment for chronic rejection.  Most people go back on dialysis or have another transplant.

Why it is done
Kidney transplant surgery is done so that a healthy kidney (donor kidney) can replace your diseased kidney.  Kidney transplant is used when you have severe chronic kidney disease (renal failure) that cannot be reversed by another treatment method.  You will not be able to have this surgery if you have an active infection, another life-threatening disease such as cancer, or severe heart or lung disease.

How well it works
If you have severe chronic kidney disease and choose to have a kidney transplant, you may live longer than if you choose only to treat your kidney disease with dialysis alone.

Transplants using a kidney from a first-degree relative, such as your father, mother, brother, or sister, are the most successful.  And transplants from living donors are usually more successful than transplants from deceased donors.

Risks
The risks of having a kidney transplant include:

• Rejection of the new kidney.
• Severe infection.
• Bleeding.
• Reaction to the anesthesia used for surgery.
• Failure of the donor kidney.

 What to think about
Kidney transplant may be a better treatment for you than dialysis, because survival rates are better after transplant.  You will also be able to live a more normal life, because you won’t have to have dialysis.  Although a kidney transplant is an expensive procedure, it may actually be less costly than long-term dialysis treatments.

There is often a long wait before you receive a donor kidney.  And there is no guarantee that the transplant will be successful.  Fewer complications occur in people who are good candidates for surgery and who do not have other serious medical conditions, such as unstable coronary artery disease or cancer, that may limit their life expectancy.

Not everyone is able to have a kidney transplant.  You will not usually have a kidney transplant if you have an active infection or another life-threatening disease, such as cancer or significant heart of lung disease.

After having a kidney transplant, you will have to take medicines that suppress your immune system (immunosuppressive medicines) to help prevent your body from rejecting the new kidney.  You will need to take these medicines for the rest of your life.  Because these medicines weaken your immune system, you will have an increased risk for serious infections.  There is also the chance that your body may still reject your new kidney even if you take these medicines.  If this happens, you will have to start dialysis and possibly wait for another kidney transplant.

Immunosuppressive medicines also increase your risk of other diseases, such as skin cancer and lymphoma.  You have a greater risk for diabetes, high blood pressure, heart disease, cataracts, and inflammation of the liver (cirrhosis) if you are taking these medicines.