Kidney Transplant

Kidney transplant & COVID-19

Find answers about transplant during the COVID-19 outbreak on the What you need to know about COVID-19 in 2022 page.

What is a kidney transplant?

What is a kidney transplant?

When you get a kidney transplant, a healthy kidney is placed inside your body to do the work your own kidneys can no longer do. The healthy kidney can come from someone has died and chosen to donate, called a deceased donor, or from someone who has two healthy kidneys and chooses to donate one, called a living donor.

A successful kidney transplant may allow you to live longer and to live the kind of life you were living before you got kidney disease. For many patients, there are fewer limits on what you can eat and drink, though you should follow a heart-healthy diet and maintain a healthy weight to help your new kidney last. Your health and energy should also improve. Studies show that people with kidney transplants live longer than those who remain on dialysis.

Having a kidney transplant does not “cure” kidney disease. There are also risks, including the risks of surgery. After the transplant, you will need to take anti-rejection medicines for as long as your new kidney is working, which can have side effects. You will have a higher risk for infections and certain types of cancer.

Although most transplants are successful and last for many years, how long they last can vary from one person to the next. Depending on your age, many people will need more than one kidney transplant during a lifetime.

Transplant

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What is a “preemptive” or “early” transplant?

Getting a transplant before you need to start dialysis is called a preemptive transplant. It allows you to avoid dialysis altogether. Getting a transplant not long after kidneys fail (but with some time on dialysis) is referred to as an early transplant. Both have benefits. Some research shows that a pre-emptive or early transplant, with little or no time spent on dialysis, can lead to better long-term health. It may also allow you to keep working, save time and money, and have a better quality of life. If your doctor has told you that your kidney disease is progressing or that you are in a later stage of kidney disease, called Stage 3B, Stage 4, or Stage 5, it could be a good time to talk about kidney transplant.

Who can get a kidney transplant?

Kidney patients of all ages—from children to seniors—are able to consider a transplant. For most people, getting a transplant can be a good treatment choice.

Every person being considered for transplant will complete a full medical and psychosocial evaluation at a transplant center to make sure they are a good candidate. The evaluation helps find any problems, so they can be corrected before transplant. You must be healthy enough to have the operation. You must also be free from cancer and infection.

What if I’m older or have other health problems?

In many cases, people who are older or have other health conditions like diabetes can still have successful kidney transplants. Careful evaluation at a transplant center is needed to understand and deal with any special risks. You may be asked to do some things that can lessen certain risks and improve the chances of a successful transplant. For example, you may be asked to lose weight or quit smoking. Only a transplant center can decide if you are healthy enough to receive a kidney transplant.

If you have diabetes, you may also be able to have a pancreas transplant. Ask your healthcare professional about getting a pancreas transplant along with a kidney transplant.

How will I pay for a transplant?

Medicare covers about 80% of the costs associated with an evaluation, transplant operation, follow-up care, and anti-rejection medicines. Private insurance through your job and state insurance programs may cover some costs as well. However, your post-transplant expenses may only be covered for a limited number of years. It’s important to discuss insurance coverage with your social worker and the transplant financial coordinator, who can answer your questions or direct you to others who can help. Click here to learn more about insurance and transplant.

Getting a Transplant

How do I start the process of getting a kidney transplant?

Ask your healthcare provider to refer you to a transplant center for an evaluation, or contact a transplant center in your area. Any kidney patient can ask for an evaluation, with or without a referral from their doctor.

How does the evaluation process work?

The evaluation process for a transplant is very thorough. Your healthcare team will need to know a lot about you to help them—and you—decide if a transplant is right for you. Medical professionals will give you a complete physical exam, review your health records, and order a series of tests and X-rays to learn about your overall health. Everything that can affect how well you can handle a transplant will be checked.

One thing you can do to speed the process is to get all the testing done as quickly as possible and stay in close contact with the transplant team. If you’re told you might not be right for a transplant, don’t be afraid to ask why. You can also consider doing an evaluation at another center if one center says no. Remember, being active in your own care is one of the best ways to stay healthy.

If someone you know would like to donate a kidney to you, that person will also need to go through a screening evaluation to find out if he or she is healthy enough to donate.

If it’s your child who has kidney disease, transplant can be the best treatment for them. Transplantation allows children and young adults to develop in as normal a way as possible in their formative years. If your child has kidney disease, you’ll want to give serious thought to getting a transplant evaluation for him or her.

If the evaluation process shows that a transplant is right for you or your child, the next step is getting a suitable kidney. (See "Finding a Kidney" below.)

What happens during kidney transplant surgery?

The operation to place a donated kidney takes about four hours. The donated kidney is placed into your lower abdomen (belly), where it’s easiest to connect it to your important blood vessels and bladder. You may be surprised to learn that your own kidneys generally aren’t taken out when you get a transplant. The surgeon leaves them where they are unless there is a medical reason to remove them.

After surgery, you’ll be sore at first, but you should be out of bed in a day or so, and home from the hospital within a week. If the kidney came from a living donor, it should start to work very quickly. A kidney from a deceased donor can take longer to start working—two to four weeks or more. This is called “delayed graft function”. If that happens, you may need dialysis until the kidney begins to work.

After surgery, you’ll be taught about the medicines you’ll have to take and their side effects. You’ll also learn about how your diet may change after transplant. If you’ve been on dialysis, you’ll find that there are fewer restrictions on what you can eat and drink, which is one of the benefits of a transplant. You will want to eat a healthy diet and exercise to take good care of your body and your new kidney.

What are anti-rejection medicines?

Normally, your body fights off anything that isn’t part of itself, like germs and viruses. That system of protection is called your immune system. To stop your body from attacking or rejecting the donated kidney, you will have to take medicines to keep your immune system less active (called anti-rejection medicines or immunosuppressant medicines). You’ll need to take them as long as your new kidney is working. Without them, your immune system would see the donated kidney as “foreign,” and would attack and destroy it.

Anti-rejection medicines can have some side effects. It is important to talk to your healthcare provider about them, so that you know what to expect. Fortunately, for most people, side effects are usually manageable. Changing the dose or type of medicine can often ease some of the side effects.

Besides the immunosuppressive medicines, you will take other medicines as well. You will take medicines to protect you from infection, too. Most people find taking medicines a small trade for the freedom and quality of life that a successful transplant can provide.

Finding a Kidney

Where do donated kidneys come from?

A donated kidney may come from someone who died and donated a healthy kidney, called a deceased donor. Donated kidneys also can come from a living donor. This person may be a blood relative (like a brother or sister) or non-blood relative (like a husband or wife). They can also come from a friend or even a stranger. You do not need to have the same blood type as your donor to get a kidney if you are in a paired exchange program. Visit the Programs for Donor/Recipient Pairs with Incompatible Blood Types page to learn more about paired exchange programs.

Kidneys from living or deceased donors both work well and can be good options, but kidneys from a living donor may last longer and are more likely to start working right away than a kidney from a deceased donor. Another plus is that when a kidney is donated by a living person, the operations can be scheduled at a convenient time for both the patient and the donor.

Finding a living donor can also help you get a kidney faster since waiting for a deceased donor kidney can take many years.

How do I get a kidney from a deceased donor?

To get a deceased donor kidney, you will be placed on a waiting list once you have been cleared for a transplant. It can take many years for a good donor kidney to be offered to you. From the time you go on the list until a kidney is found, you may have to be on some form of dialysis. While you’re waiting, you’ll need regular blood tests to make sure you are ready when a kidney is found. If you’re on dialysis, your center will make the arrangements for these tests. Your transplant center should know how to reach you at all times. Once a kidney become available, the surgery must be done as soon as possible.

How do I get a kidney from a living donor?

To receive a kidney from a living donor, you must first be cleared by a transplant center after completing an evaluation. After that, the best place to start is by sharing your story with people you know and your community. Talk to your family and friends about your kidney failure and your need for a donor.

To learn more about how to find a living donor, visit this link.

Are there downsides to living donation?

A healthy person who donates a kidney can live a normal life with the one kidney that is left, but a kidney donor must undergo surgery to remove a kidney and give it to the recipient. The operation is major surgery for the donor, as well as the recipient. As in any operation, there are some risks that you will want to consider , including surgery risks and long-term risks.

The donor will need time to recover before returning to work and other activities. However, recent advances in surgery (often called minimally invasive or laparoscopic surgery) allow for very small incisions. This means shorter hospital stays and recovery time, less pain, and a quicker return to usual activities. Living donors often experience positive feelings about their courageous gift. Learn more about living donation here.

What are the financial costs to the living donor?

The surgery and evaluation are covered by Medicare or the recipient’s insurance. The living donor will not pay for anything related to the surgery. However, neither Medicare nor insurance covers time off from work, travel expenses, lodging, or other incidentals. The National Living Donor Assistance Program (www.livingdonorassistance.org) or other programs may help cover travel and lodging costs.

Donors may be eligible for sick leave, state disability, and benefits under the federal Family Medical Leave Act. In addition, federal employees, some state employees, and certain other workers may be eligible for 30 days paid leave.

After Your Transplant

What happens after I go home?

Once you are home from the hospital, the most important work begins—the follow-up. For your transplant to be successful, you will have regular checkups, especially during the first year. At first, you may need blood tests several times a week, then once a week, then less often. As times passes, if you are doing well, you’ll need fewer checkups, but enough to make sure that your kidney is working well and that you have the right amount of anti-rejection medication in your body.

What if my body tries to reject the new kidney?

One thing that you and your healthcare team will watch for is acute rejection, which means that your body is suddenly “attacking” or trying to reject the transplanted kidney. A rejection episode may not have any clear signs or symptoms. That is why it is so important to have regular blood tests to check how well your kidney is working. Even though rejection can happen without symptoms, let your healthcare team know if you notice you are having fevers, peeing less or less often, swelling, weight gain, or pain over your kidney.

The chances of having a rejection episode are highest right after your surgery. The longer you have the kidney, the lower the chance that this will happen. Unfortunately, sometimes a rejection episode happens even if you’re doing everything you’re supposed to do. Sometimes the body just doesn’t accept the transplanted kidney. But even if a rejection episode happens, there are many ways to treat it so you do not lose your transplant. Letting your transplant team know right away that you think you have symptoms of rejection is very important so they can treat it and help keep your transplanted kidney, and you, healthy.

How often does rejection happen?

Rejections happen much less often than they used to. That’s because there have been many improvements in immunosuppressive medicines. However, the risk of rejection is different for every person. For most people, rejection can be stopped with special anti-rejection medicines. It’s very important to have regular checkups and tests to see how well your kidney is working, and make sure you are not having rejection.

When can I return to work?

How soon you can return to work depends on your recovery, the kind of work you do, and your other medical conditions. Many people can return to work eight weeks or more after their transplant, but sometimes it can be sooner or later. Your transplant team will help you decide when you can go back to work.

How will a transplant affect my sex life? Can I still have children?

People who have not had satisfactory sexual relations due to kidney disease may notice an improvement as they begin to feel better. In addition, fertility (the ability to conceive and have children) tends to increase. Men who have had a kidney transplant have fathered healthy children, and women with kidney transplants have had successful pregnancies. Talk to your healthcare practitioner when considering having a child.

Women should avoid becoming pregnant too soon after a transplant. Most centers want women to wait a year or more. All pregnancies should be planned together with your care team. Certain medications can harm a developing baby, so they must be stopped at least six weeks before trying to get pregnant. Birth control or family planning counseling may be helpful.

It’s important to protect yourself against sexually transmitted diseases (STDs). Be sure to use protection during sexual activity.

Will I need to follow a special diet?

In general, transplant recipients should eat a heart-healthy diet (low fat, low salt) and drink plenty of fluids. If you have diabetes or other health problems, you may still have some dietary restrictions. A dietitian can help you plan meals that are right for you.

What else can I do?

You should learn as much as you can by reading and talking to your healthcare team, as well as patients who already have kidney transplants.

To obtain a free copy of a brochure about kidney transplant, call 855.NKF.CARES (855.653.2273) or email nkfcares@kidney.org and ask for “Kidney Transplant: What You Need to Know.”

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Kidney Transplant

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Kidney transplant & COVID-19