A kidney transplant is a procedure to replace a kidney that is no longer functioning properly with a healthy kidney. The healthy kidney will then carry out the function of both kidneys.

A kidney transplant is a treatment option for kidney failure, rather than a cure.

People with kidney failure often need dialysis, a procedure that removes excess fluid and waste from the body when the kidneys are unable to do so. A person with end stage kidney failure may undergo a kidney transplant as an alternative to permanent dialysis.

This article looks at the stages of the kidney transplant process, what to expect, and the outlook after the procedure.

A surgeon examining the tools used in kidney transplant surgery.Share on Pinterest
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According to the National Kidney Foundation (NKF), kidney transplants can vary based on the type of donor and the timing of the transplant.

A kidney can come from a donor who has recently died. The wait for a deceased donor may be long, as the demand for transplants is greater than the number of donors.

Alternatively, a kidney for transplant can come from a living donor. A family member, a friend, or another individual who is a suitable match for the transplant recipient may choose to donate one of their kidneys.

It is possible to get a preemptive, or early, transplant, which occurs before a person needs to start dialysis. People may wish to speak with a doctor about getting a preemptive transplant if they have received a diagnosis of stage 3B, 4, or 5 kidney disease.

To become a candidate for a transplant, a person will need to join a nationwide waiting list with the United Network for Organ Sharing (UNOS).

Factors that determine when a person will receive a transplant vary for each transplant center but may include:

  • overall health
  • age
  • the duration of kidney failure
  • medical urgency
  • blood type
  • a person’s location in relation to the transplant center

What disqualifies a person from getting one?

While each transplant center may have different criteria, some factors can disqualify a person from receiving a kidney transplant, including:

  • a recent or current cancer diagnosis
  • not being healthy enough to survive a transplant procedure
  • an active infection
  • smoking
  • obesity or overweight
  • substance misuse
  • severe heart disease

Potential risks of kidney transplant include:

  • complications from surgery, such as bleeding, infection, or blockage of the blood vessels supplying the new kidney
  • a delay in the functioning of the new kidney, which means people will require temporary dialysis
  • rejection of the new kidney
  • side effects from antirejection medications

A healthcare professional can refer people to a transplant center, or people can refer themselves.

A transplant center will carry out an evaluation to see whether a person is a suitable candidate. This may include:

  • medical history
  • mental health assessment
  • blood tests to help find a suitable match
  • diagnostic tests, such as X-rays and kidney biopsy, to check kidney health and overall health

When choosing a center, people may want to consider:

  • cost and insurance coverage
  • location, which needs to be easy to get to at short notice
  • whether the center performs transplants with living donors
  • whether the center offers paired donation, which pairs people with another donor if a living donor is not compatible
  • whether the center offers support groups

If a person is receiving a kidney from a deceased donor, they will join a waiting list. Wait times may vary from a few months to years.

The following factors may affect a person’s wait time:

  • how long they have already been waiting
  • their age
  • their blood type
  • their location

People may need dialysis while they wait for a transplant. People will also need to have blood tests each month to provide a recent blood sample to the center for matching purposes.

As soon as a suitable match becomes available, the transplant center will contact the person and they will need to get to the center right away.

If a person has a living donor, they may have a set date for the procedure and instructions for how to prepare. People will usually need to fast for 8 hours before surgery.

People should follow any exercise and dietary guidelines from a healthcare professional and attend all scheduled appointments.

If a person is receiving a transplant from a living donor, the donor and the recipient will usually be in adjacent rooms to receive surgery so that the transplant can happen as quickly as possible.

The procedure usually takes 3–4 hours.

The recipient’s surgeon will perform the following steps:

  1. Once the anesthesia has taken effect, they will insert a tube through the mouth and into the lungs. This tube is attached to a ventilator that will help a person breathe during the surgery.
  2. They will cleanse the surgical site with an antiseptic solution and make a long incision in the lower abdomen.
  3. The surgeon will inspect the donor kidney and then place it into the recipient’s abdomen. The left donor kidney is placed on the right side, and the right donor kidney is placed on the left side.
  4. They will sew the renal vein and the vein of the donor kidney to the external iliac artery and vein. This is a blood vessel in the pelvis.
  5. Once these are attached, the surgeon will check the blood flow through these blood vessels.
  6. They will connect the donor ureter to the bladder.
  7. The surgeon will close the incision using stitches or surgical staples, place a drain at the incision site, and apply a sterile bandage or dressing.

Following surgery, people may need to rest in bed for 1–2 days. People will usually be able to leave the hospital within a week after surgery.

If a person receives a kidney from a living donor, it may start to function soon after the procedure.

A kidney from a deceased donor can take longer to start working, and people may need dialysis for 2–4 weeks or longer, until the kidney begins to work.

People may be able to return to work around 8 weeks after a transplant, but this can vary for each individual.

Antirejection medicines

To stop the recipient’s body from attacking or rejecting the new kidney, a doctor will prescribe antirejection medications. These include:

  • calcineurin Inhibitors
  • antiproliferative agents
  • mTOR inhibitor
  • steroids

Antirejection medications can cause side effects, such as an increased chance of infection or upset stomach. However, these side effects are usually manageable.

Some foods and medications can interact with the antirejection medications. People should avoid:

  • grapefruit
  • St John’s wort
  • erythromycin
  • antiseizure medications
  • blood pressure medications such as cardizem, verpamil, and diltiazem
  • anti-tuberculosis medications

Diet and nutrition

A person will usually need to eat a diet that supports the heart and is low in fat and salt. They will also need to drink plenty of fluids.

It is important that people follow their healthcare team’s instructions after a transplant.

Exercise after a transplant

People may have to follow certain exercise guidelines while they recover from surgery. They may need to avoid any activity or position that puts pressure on the new kidney.

A person can discuss an exercise plan with their healthcare team.

A person should contact a doctor if they experience any symptoms of infection, including:

  • a fever above 100ºF (37°C)
  • a burning sensation when urinating
  • a cough or cold that does not resolve
  • drainage from the surgical scar

The 2022 national survival rates include recipient survival rate, which refers to people who have received a transplant, and graft survival rate, which refers to the survival rate of the implanted kidney.

For kidney transplants from deceased donors, the 1-year recipient survival rate is 94.72% and the 1-year graft survival rate is 92.48%.

For kidney transplants from living donors, the 1-year recipient survival rate is 98.40% and the 1-year graft survival rate is 97.66%.

In a 2017 study that included 452 kidney transplant recipients with a median age of 65 years, the survival rates for the recipients and grafts were as follows:

Time frameRecipient survival rateGraft survival rate
1 year98.7%94.4%
3 year93%87.9%
5 year89%81.4%

Increasing age was a risk factor for lower survival rates of both the recipient and the graft.

According to the American Kidney Fund, the average survival time is 15–20 years for a kidney transplant from a living donor and 10–15 years for a kidney transplant from a deceased donor.

After this time, people may need a new transplant or dialysis.

According to the United States Renal Data System 2020 Annual Data Report, outcomes from deceased donor kidney transplants are improving, and outcomes from living donor kidney transplants are excellent.

People may find the following resources helpful for coping tips and support:

If people have Medicare, it will pay for the transplant and 3 years of care after the procedure, as well as the surgery and care of a living donor.

Health insurance may also help cover some medication costs.

If people do not have health insurance, some resources may help. Drug companies may also provide discounts to people who are unable to afford prescription costs.

The following are frequently asked questions about kidney transplants.

What is the best age for a kidney transplant?

According to the NKF, kidney transplant is an option for people of all ages who have kidney failure, including children and older adults.

People will need to be healthy enough to receive surgery. A kidney transplant may still be a suitable option for people who are older or have certain health conditions, such as diabetes.

How many transplants can a person have?

It is possible to have multiple kidney transplants during a lifetime. Depending on their age, many people with kidney failure may require more than one kidney transplant over time.

People can discuss with a healthcare professional whether this may be an option for them.

What happens to the old kidney?

If a person’s old kidneys are not causing infection and are noncancerous, they may remain in the person’s body, and a surgeon will insert the new kidney into the lower abdomen.

A kidney transplant can be an alternative treatment option for people with end stage kidney failure. People can receive a kidney from a deceased donor or a living donor.

People will have to undergo an evaluation to assess whether they are eligible before joining a waiting list to receive a transplant.

People will need to follow the advice of healthcare professionals before and after surgery to ensure the best recovery.