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Get the facts. And the help you need.

Kidney (Renal) Transplantation

Kidney transplantation is one of the most common and successful organ transplant procedures performed today. Thanks to decades of fine-tuning, renal transplantation has become a life-saving alternative for thousands of patients with end-stage renal disease.

For patients with kidney failure and those who are not candidates for transplantation, dialysis can sustain life. But what can you expect from either option? The information below can help you discuss renal treatment with your urologist.

What happens under normal conditions?

The kidneys are fist-sized organs responsible for the fluid and chemical balances of your body. Located on both sides of the spine behind the liver, stomach, pancreas and intestines, these two organs are protected by the lower ribs and muscles of the back and sides.

When healthy, your kidneys cleanse the blood of waste products and produce urine. They also balance essential elements, such as sodium and potassium, while providing hormones necessary to regulate blood pressure and red blood cell production.

When these organs fail, harmful wastes build up in your body, leading to high blood pressure, increased fluid retention, imbalances in salts and acids in the blood, and decreased red blood cell production. All of those events can have harmful, possibly life-threatening effects on your heart and brain.

What causes kidney failure?

Each year about 90,000 Americans develop end-stage renal disease. The most prevalent causes of chronic kidney failure include diabetes, high blood pressure and glomerulonephritis, an inflammation of the organ's filtering units. These conditions account for three-quarters of reported end-stage cases.

What are the symptoms of kidney failure?

There are many symptoms associated with kidney failure. You may experience swelling in your hands, feet and face along with headaches due to high blood pressure, and even seizures. Your complexion may pale due to anemia, and your urine may become coffee-colored. You may also have chronic bad breath that cannot be freshened by brushing your teeth. You may have fatigue and itchy skin.

How is kidney failure treated?

The most common treatment for end-stage kidney disease is dialysis. This is the process of removing waste, excess water and chemicals (e.g., potassium, sodium, calcium and acid) from the body. There are two types of dialysis: hemodialysis and peritoneal dialysis.

In hemodialysis, the patient's blood stream is connected to an artificial kidney machine outside the body. Hemodialysis treatments are usually done three times per week and take from two to six hours for each session. Many patients with kidney failure undergo peritoneal dialysis, a similar cleansing process conducted through a tube in the abdomen. 

While hemodialysis and peritoneal dialysis will not cure kidney failure, they can replace the work of your kidneys, helping you feel better and live longer.

About 30 percent of kidney failure sufferers are suitable candidates for a kidney transplant, a surgical procedure to restore function by replacing two failed kidneys with one healthy organ.

About half of kidney transplants come from non-living (or deceased) donors, even though family members, spouses (living, related donors) and friends (living, unrelated donors) can safely donate if tests can prove they'll have nearly normal kidney function after giving up one kidney.

A kidney transplant is usually placed in the lower abdomen without any need to remove the failed kidneys. The new kidney's artery is connected to one of the patient's pelvic arteries. The kidney's vein is connected to one of the veins in the patient's pelvis. The ureter, the tube that drains urine from the kidney, is connected to the bladder or to one of the patient's own ureters. In children, the blood vessels from a large adult kidney transplant are frequently connected to the child's aorta and inferior vena cava.

What can be expected after treatment for kidney failure?

If you are the donor, you can expect to leave the hospital between two to four days after the surgery. If your kidney was removed with a traditional operation, expect a single incision about eight inches in length. If, however, your doctor has used laparoscopic surgery, a minimally invasive procedure, you will have four smaller incisions, the largest of which will be about four inches long.

If you are the recipient of the transplant, you will have a catheter in your bladder and an intravenous feeding tube through your arm and/or neck vein for a few days after the procedure. You can expect to be up, out of bed and walking within 24 hours and discharged in five to seven days. While urine often flows immediately, sometimes the new kidney does not work effectively right away. So do not be surprised if you need temporary dialysis.

About 90 percent of transplanted kidneys are functioning at the end of one year. Between 3 percent to 5 percent of these kidneys stop working each year after that. The kidney is always at risk for rejection, so it is very important for kidney transplant patients to take all of their medicines as directed to prevent this problem. Overall, a kidney from a living donor has a better survival rate than a kidney from a non-living donor.

The chance that you will have a recurrence of kidney disease in your transplant depends on the cause of your kidney failure. For instance, it does not occur with autosomal dominant polycystic kidney disease, or other inherited disorders. It is possible with conditions such as hemolytic uremic syndrome, a rare disorder marked by kidney failure, or focal segmental glomerulosclerosis, a severe disease in which scar tissue replaces the kidney's filtering glomeruli.

Frequently asked questions:

What are the risk factors for kidney failure?

Any number of risk factors can contribute to kidney failure including high blood pressure, hardening of the arteries and diabetes. It can be brought on by untreated strep infections, recurrent and chronic kidney infections, systemic lupus erythematosus, severe forms of diarrhea, kidney stones or even chronic use of non-steroidal anti-inflammatory drugs.

I'd like to donate one of my kidneys to my brother but our blood types are not identical. Does it matter?

No. Blood types do not have to be identical, just compatible. Markers or "antigens" on the surfaces of your red blood cells determine your type.

ABO blood group incompatibility between the donor and recipient can provoke an immediate rejection. This means that a donor with "O" blood type can donate a kidney to a patient who has "O," "A," "B" or "AB" blood type and that transplant candidates with "A" or "B" blood types are usually limited to kidney transplants from donors with the same blood type or "O" blood type.

Antibodies, proteins manufactured by the immune system that react specifically to donor tissue. A "negative cross-match" or lack of reaction when blood samples from a donor and recipient are test tube mixed confirms when a kidney is acceptable.

How long will I have to wait for a kidney transplant if I do not have a living donor?

The waiting period for a deceased donor kidney varies from patient to patient, depending most on patient blood group and degree of antibodies in the blood. Since there are not enough deceased donor organs for every person who needs a transplant, potential recipients are placed on a national list, administered by the United Network for Organ Sharing (UNOS), a private nonprofit organization contracted by the federal government.

Each time an organ becomes available, a recipient is chosen based on a point system reflecting blood type, waiting time, tissue match and antibody levels. Although some people receive their organ within several months, the median delay is two to three years. In contrast, a living-donor transplant can be scheduled immediately, thus making it an optimal choice.

My father had autosomal dominant polycystic kidney disease. What is the chance that I will have the same disease?

The chance that you have inherited this condition is about 50 percent. Autosomal dominant polycystic kidney disease should not be confused with multiple simple cysts of the kidneys, which occur commonly with age. Instead, this disease results in a build-up of benign growths that gradually increase in size until they destroy the normal tissue of both kidneys.

Symptoms like abdominal swelling, pain, bloody urine and frequent urinary tract infections may occur at any time but they usually begin in middle age. High blood pressure and renal failure may result as the disease progresses. Although there is no effective treatment to preserve kidney function in patients with autosomal dominant polycystic kidney disease, dialysis or a kidney transplant can be used to treat the kidney failure.



Reviewed January 2011

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Kidney (Renal) Transplantation Glossary
  • abdomen: Also referred to as the belly. It is the part of the body that contains all of the internal structures between the chest and the pelvis.

  • abdominal: in the abdomen, the cavity of this part of the body containing the stomach, intestines and bladder.

  • anemia: The condition of having too few red blood cells to carry oxygen throughout the body. People with anemia may be tired and pale, experience shortness of breath and/or may feel their heartbeat change. Anemia is common in people with chronic renal failure or those on dialysis.

  • antibodies: Proteins that fight infections.

  • antibody: Protein that fights infections.

  • aorta: The largest artery in the body.

  • arteries: Blood vessels that carry blood from the heart to various parts of the body.

  • artery: Blood vessel that carries blood from the heart to various parts of the body.

  • autosomal dominant polycystic kidney disease: Genetic disorder that results in an enlarged organ with many cysts that overtake healthy tissue and eventually causes kidney failure.

  • benign: Not malignant; not cancerous.

  • bladder: The bladder is a thick muscular balloon-shaped pouch in which urine is stored before being discharged through the urethra.

  • calcium: A mineral that the body needs for strong bones and teeth. Calcium may form stones in the kidney.

  • catheter: A thin tube that is inserted through the urethra into the bladder to allow urine to drain or for performance of a procedure or test, such as insertion of a substance during a bladder X-ray.

  • chronic: Lasting a long time. Chronic diseases develop slowly. Chronic renal (kidney) failure may develop over many years and lead to end-stage renal (kidney) disease.

  • contract: To shrink or become smaller.

  • cyst: An abnormal sac containing gas, fluid or a semisolid material. Cysts may form in kidneys or other parts of the body.

  • cystic: Used to describe a cyst or material that forms, contains or is enclosed in a cyst.

  • cysts: Abnormal sacs containing gas, fluid or a semisolid material.

  • diabetes: A medical disorder of increased blood sugar levels that can cause bladder and kidney problems.

  • dialysis: A technique to remove waste products from the blood and excess fluid from the body as a treatment for renal (kidney) failure. Restores electrolyte and water balance within the body. This job is normally done by the kidneys. The two major forms of dialysis are hemodialysis and peritoneal dialysis.

  • dialysis : The process of cleaning wastes from the blood artificially. This job is normally done by the kidneys. If the kidneys fail, the blood must be cleaned artificially with special equipment. The two major forms of dialysis are hemodialysis and peritoneal dialysis.

  • focal segmental glomerulosclerosis: Focal segmental glomerulosclerosis" is an illness where scar tissue forms in some of the glomeruli of the kidney.

  • glomeruli: Plural of glomerulus. Small balls of tiny blood vessels that assist the kidneys in filtering urine from the blood.

  • glomerulonephritis: A type of kidney disease in which the kidney's filtering (glomeruli) become inflammed and scarred and slowly lose their ability to remove wastes and excess fluid from the blood to make urine.

  • glomerulonephritis: Renal disease characterized by bilateral inflammatory changes in glomeruli which are not the result of infection of the kidneys.

  • glomerulosclerosis: Scarring of the glomeruli, the small balls of tiny blood vessels that assist the kidneys in filtering blood and making urine.

  • hardening of the arteries: Common descriptive expression referring to a group of diseases (forms of arteriosclerosis) characterized by abnormal thickening and hardening (sclerosis) of arterial walls, in which the walls lose their elasticity.

  • hemodialysis: See dialysis

  • hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body.

  • hemolytic uremic syndrome: Also referred to as HUS. A rare kidney disorder that mostly affects children under the age of 10. Often characterized by damage to the lining of blood vessel walls, destruction of red blood cells and/or kidney failure.

  • high blood pressure: Medical term is hypertension.

  • hormone: A natural chemical produced in one part of the body and released into the blood to trigger or regulate particular functions of the body. Antidiuretic hormone tells the kidneys to slow down urine production.

  • immune system: The body's system for protecting itself from viruses and bacteria or any "foreign" substances.

  • incision: Surgical cut for entering the body to perform an operation.

  • infection: A condition resulting from the presence of bacteria or other microorganisms.

  • inferior vena cava: A large vein that receives blood from the lower extremities, pelvis and abdomen and empties it into the right atrium of the heart.

  • inferior vena cava: A large vein that receives blood from the lower extremities, pelvis and abdomen and empties it into the right atrium of the heart.

  • inflammation: Swelling, redness, heat and/or pain produced in the area of the body as a result of irritation, injury or infection.

  • inflammatory: Characterized or caused by swelling, redness, heat and/or pain produced in an area of the body as a result of irritation, injury or infection.

  • intestine: The part of the digestive system between the stomach and the anus that digests and absorbs food and water.

  • intestines: the portion of the alimentary canal extending from the stomach to the anus consisting of two segments, the small intestine and the large intestine.

  • intravenous: Also referred to as IV. Existing or occurring inside a vein.

  • invasive: Having or showing a tendency to spread from the point of origin to adjacent tissue, as some cancers do. Involving cutting or puncturing the skin or inserting instruments into the body.

  • invasive: Not just on the surface; with regard to bladder cancer, a tumor that has grown into the bladder wall.

  • ions: Electrically charged atoms.

  • kidney: One of two bean-shaped organs that filter wastes from the blood and discharge these waste products in urine. The kidneys are located on either side at the level of the 12th ribs toward the back. The kidneys send urine to the bladder through tubes called ureters.

  • kidney infection: Also called pyelonephritis. Urinary tract infection involving the kidney. Typical symptoms include abdominal or back pain, fever, malaise and nausea or vomiting.

  • kidney stone: A stone that develops from crystals that form in urine and build up on the inner surfaces of the kidney, in the renal pelvis or in the ureters. (Also see nephrolithiasis.)

  • kidneys: One of two bean-shaped organs that filter wastes from the blood and discharge these waste products in urine. The kidneys are located on either side at the level of the 12th ribs toward the back. The kidneys send urine to the bladder through tubes called ureters.

  • laparoscopic: Using an instrument in the shape of a tube that is inserted through the abdominal wall to give an examining doctor a view of the internal organs.

  • laparoscopic surgery: Surgery performed with an instrument in the shape of a tube that is inserted through small cuts. Using a small video camera and a few customized instruments, the surgeon can work in many body cavities without dividing skin from muscle thus reducing recovery time and complications.

  • liver: A large, vital organ that secretes bile, stores and filters blood, and takes part in many metabolic functions, for example, the conversion of sugars into glycogen. The liver is reddish-brown, multilobed, and in humans is located in the upper right part of the abdominal cavity.

  • nephritis: Inflammation of the kidneys.

  • non-steroidal: Drug not containing or being a steroid. Ibuprofen is an example.

  • pelvic: Relating to, involving or located in or near the pelvis.

  • pelvis: The bowl-shaped bone that supports the spine and holds up the digestive, urinary and reproductive organs. The legs connect to the body at the pelvis.

  • peritoneal dialysis: See dialysis.

  • peritoneal dialysis: Cleaning the blood by using the lining of the belly (abdomen) as a filter. A cleansing solution, called dialysate, is drained from a bag into the belly. Fluids and wastes flow through the lining of the belly and remain "trapped" in the dialysate. The dialysate is then drained from the belly, removing the extra fluids and wastes from the body. There are three types of peritoneal dialysis.

  • polycystic kidney disease: Also referred to as ADPKD. An inherited disorder characterized by many grape-like clusters of fluid-filled cysts that make both kidneys larger over time. These cysts take over and destroy working kidney tissue. ADPKD may cause chronic renal failure and end-stage renal disease.

  • potassium: An alkali element.

  • pus: The yellowish or greenish fluid that forms at sites of infection.

  • renal: Pertaining to the kidneys.

  • renal failure: Loss of the kidney's ability to excrete wastes, produce urine and conserve electrolytes.

  • renal transplantation: A surgical procedure that places a healthy kidney from one person into another.

  • retention: In ability to empty urine from the bladder, which can be caused by atonic bladder or obstruction of the urethra.

  • stage: Classification of the progress of a disease.

  • steroid: An organic fat-soluble compound.

  • stoma: An opening.

  • stone: Small hard mass of mineral material formed in an organ.

  • systemic: Affecting the whole body.

  • systemic lupus erythematosus: A long-lasting rheumatic disease which affects joints, muscles and other parts of the body, including the kidneys.

  • tissue: Group of cells in an organism that are similar in form and function.

  • transplant: Replacement of a diseased organ with a healthy one. A kidney transplant may come from a living donor or from someone who has just died.

  • uremic: Relating to uremia, which is the illness associated with the buildup of urea in the blood because the kidneys aren't working effectively.

  • ureter: One of two tubes that carry urine from the kidneys to the bladder.

  • ureters: Pair of tubes that carry urine from each kidney to the bladder.

  • ureters: Tubes that carry urine from the kidneys to the bladder.

  • urge: Strong desire to urinate.

  • urinary: Relating to urine.

  • urinary tract: The system that takes wastes from the blood and carries them out of the body in the form of urine. Passageway from the kidneys to the ureters, bladder and urethra.

  • urinary tract infection: Also referred to as UTI. An illness caused by harmful bacteria, viruses or yeast growing in the urinary tract.

  • urine: Liquid waste product filtered from the blood by the kidneys, stored in the bladder and expelled from the body through the urethra by the act of urinating (voiding). About 96 percent of which is water and the rest waste products.

  • urologist: A doctor who specializes in diseases of the male and female urinary systems and the male reproductive system. Click here to learn more about urologists. (Download the free Acrobat reader.)

  • urology: Branch of medicine concerned with the urinary tract in males and females and with the genital tract and reproductive system of males.

  • vas: Also referred to as vas deferens. The cordlike structure that carries sperm from the testicle to the urethra.

  • vein: Blood vessel that drains blood away from an organ or tissue.

  • vena cava: Vein carrying blood to the heart.

Kidney (Renal) Transplantation Anatomical Drawings

click images for a larger view
 

 

 

 

 

 

 

 

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