When a Transplant Fails

By Lara E. Tushla, LCSW

Everyone talks about the success rates of kidney transplants. Rarely do we talk about what happens when transplants fail.

In the transplant evaluation process, transplant programs talk about the success rates and risks, including that the kidney may never work or won't work for long, but everyone thinks they will be one of the successes. However, there are a number of reasons why a kidney transplant can fail:

Blood Clots

This condition occurs when the blood in the blood vessels to the transplanted kidney clot, so the kidney has no blood flow. This is most likely to happen shortly after the surgery.

Fluid Collection

If there is fluid collection around the kidney, there can be damage to the kidney from the pressure if it is not treated.


Having an infection in the kidney can cause permanent problems with the kidney, especially if it is not found and treated early.

Side Effect of Medicines

Some medicines can be harmful to kidneys.

Donor Kidney Problems

Transplant surgeons will only offer you a kidney that they believe will work, but sometimes there are problems with the donor kidney that are not expected and the kidney does not work well. If the kidney doesn't work well, it is not likely to last long.

Non Adherence (aka Non-Compliance)

Some people stop taking their anti-rejection medicines or miss doses. The anti-rejection medicine prevents your body from recognizing the donor kidney as a “foreign object.” Without enough of the medicine in your blood, your body “sees” the new kidney and begins to attack it. Eventually you will damage enough of your kidney that you have to go back on dialysis. Non-adherence can also cause problems if a person misses their appointments, lab tests, or other treatments.

Recurrent Disease

Although it is not very common, it is possible for the disease that damaged your original kidneys to come back and damage the transplanted kidney.

Chronic Rejection

This is the most common reason that kidney transplants fail. It is the long-term damage done by the body's immune system for a lot of different reasons.

It is important to realize that transplant patients have NO CONTROL over most of these causes of transplant failure. Transplant patients do HAVE CONTROL over taking their medicines and following treatments as prescribed, calling their transplant care provider when they are not feeling well, and otherwise staying as healthy as possible.