Your transplant operation will take place in the main operating theatre on the third floor of the Royal Free Hospital.
You will have a general anaesthetic and the operation usually lasts about two to three hours, although you are not likely to be back to the ward for four to five hours.
The transplanted kidney is placed in either the right or left groin. It is placed here as it is close to your bladder and main blood vessels of your leg.
The operation requires the surgeon to join up your blood vessels to those of the kidney and join the urine tube (ureter) from the kidney to your bladder.
Your own kidneys are not removed unless there is a reason to do so.
Occasionally, we may need to use the ureter (draining tube) from one of your own kidneys to connect up to your new kidney.
- You will have a tube placed into your bladder (a urinary catheter) to measure the amount of urine your transplanted kidney is producing. It is usually removed after about five days.
- You may have a tube or two from the operation site (a drain) to remove any blood or fluid. This is usually removed within a few days unless it continues to drain.
- You will have a plastic tube (a stent) placed inside the urine tube (ureter) that connects the kidney to your bladder. You will not be able to see this tube after the operation, as it will be inside your kidney and bladder. This prevents any kinking of the ureter after the operation and helps keep the join to the bladder patent (clear). It is usually removed after four to six weeks by a day case cystoscopy (camera to look into the bladder) under local anaesthesia (in most cases). If you have a peritoneal dialysis catheter, this will be removed at the same time as your cystoscopy under general anaesthesia.
- You will have a drip line in your hand and a central line (neckline). The central line is removed after two to three days.
- You will be given control of your analgesia (painkiller). This is attached to one of your drip lines and a control button will be placed in your hand. When you press the button, you will get a painkiller that works very quickly to prevent any further pain. This is called PCA — patient controlled analgesia. The PCA is removed after two to three days and we will give you oral painkillers instead.
The operation and anaesthetic may make your stomach stop working for a while.
Immediately after your transplant operation you will not be able to eat or drink, but after a few hours, you should be able to start drinking sips of water.
This will gradually be built up to more fluid and then a light diet. Within a couple of days, you should be eating normally. The doctor will assess how much fluid you should drink every day.
Remember, it is often necessary to drink much more fluid than you have been used to on dialysis — it may be many litres each day.
Some people may pass large amounts of urine after the transplant operation, particularly at night. This is nothing to worry about and will eventually settle down. However, it may require you to have some extra fluids through a drip.
Not always. Some kidneys will start working during the operation, but some kidneys may take time to start passing urine and clearing the waste from your body (delayed function).
Roughly 98% of kidneys from live donors work straight away, but about half the kidneys from deceased donors take time to start working.
The length of time taken for the kidney to work can vary considerably. Most kidneys start working within a week or two of transplantation but occasionally, it may take months to work. During this time, you will need to continue with your dialysis.
If you are on peritoneal dialysis, you may need a short period of haemodialysis. If by one week the transplant has not started to work, you may require a biopsy (where a small sample of tissue is taken) to determine if the kidney is undergoing rejection
Kidney transplantation is a major operation with complex surgery required to join the blood vessels and draining tube of your new kidney to your body.
Occasionally (roughly 1-2% of kidney transplants), the blood vessels can clot, or you can bleed and compress the blood supply to the kidney. In this situation the kidney loses its blood supply and has to be removed shortly after it has been transplanted.
Some kidney transplants may never work, even with good blood supply and no rejection. This happens in about 1% of kidney transplants and the kidney is usually removed after several months of waiting for it to start working.
Each individual transplant is different, and some patients will have to stay longer than others after the transplant.
If the kidney works immediately and you recover quickly, you will only have to stay in hospital for five days.
If the kidney takes time to work or the doctors feel you need more time in hospital, you may need to stay longer.
Most patients are stable enough to go home after one week to 10 days, whether their kidney has started working or not.
Yes, we will need to take blood tests whilst you are an inpatient at least once a day to monitor the function of the kidney, make sure there is no bleeding, check on the levels of drugs in your blood and a number of other tests.
After you are sent home, we will need to do blood tests each time you come to the hospital.
Yes. All transplant patients will have an ultrasound scan and nuclear medicine scan of their kidney to make sure the blood vessels supplying the kidney are patent (open), the kidney is functioning well, and the draining tube is not blocked.
You may need more scans or X-rays after the operation to make sure the kidney is working well and there are no complications.
Rejection and biopsies
Rejection can be a normal response of your body’s immune system to a foreign kidney. We will give you medication (immunosuppression) to stop you rejecting your kidney.
Despite this medication, about 10-15% of patients will reject their kidney within the first year, although this may be higher if you have a blood group or antibody incompatible transplant.
The risk of rejection decreases with time and is less likely after the first year.
Most cases of rejection are mild and can be treated with steroid injections and an increase in the amount or type of immunosuppression you take.
Occasionally, we need to treat rejection with stronger immunosuppression drugs that subdue cells of your immune system.
Stopping your prescribed medication, or not taking it properly, is likely to lead to rejection and the possible loss of your transplant. We ask that you take your medication regularly and on time to avoid rejection or other serious consequences.
Very rarely (1% of transplants), we cannot stop the kidney rejecting and we have to remove the kidney. In this case, you will return to dialysis and may be considered for another transplant in the future.
Most episodes of rejection are picked up by a change in your kidney function on the blood tests and it is unusual for you to have symptoms of rejection.
If we suspect you might be rejecting your kidney, we may ask you to have a transplant kidney biopsy.
Most patients do not need a biopsy of their kidney while they are in hospital, but if your kidney does not work after about a week or if we suspect you have rejection based on your blood tests, we may need to do a biopsy of your transplanted kidney.
If your kidney takes a long time to start working, you may need a biopsy of the transplanted kidney each week until it starts working.
In addition, your transplant doctor may ask you to have a biopsy at any time to make sure there is no rejection or infection in your kidney.
The kidney is scanned with an ultrasound machine and local anaesthetic is given at the site of the biopsy to make sure the skin on the front of your abdomen (stomach) is numb.
A special needle device is passed into the kidney from the front of your abdomen and is used to obtain a small piece of the kidney, about half the size of a matchstick.
You will then be asked to lie on your bed for the next four to six hours while the nurses monitor your blood pressure and pulse rate.
You may have had a biopsy of your own kidney. A transplant biopsy is much more straightforward than this.
Most kidney biopsies do not have any complications, but there is a small risk (about 2-5%) of bleeding.
Of the patients who bleed, a small proportion require a blood transfusion and a smaller number require a further procedure to stop the bleeding.
The risk of damaging your transplant kidney is very small and the benefit of knowing what is going on in the kidney often outweighs the small risk to you of undergoing the biopsy.
Your doctor will discuss the risks and benefits of having the biopsy done at the time.
After your kidney transplant
You will be given a supply of your new tablets and you will have to come to the transplant clinic at the Royal Free Hospital.
The frequency of clinic visits will gradually reduce over the next few months to twice weekly (Monday and Thursday) until four to six weeks post-transplant, then weekly.
By four months after the transplant, most patients are only coming once every two weeks.
After a year, most patients are only coming four or five times a year.
We need to monitor you and your kidney function very carefully after the transplant to make sure you do not have rejection, infections or any other complications.
You will have blood tests at each visit to monitor your kidney function and the effects of the medications.
You will need to have your dressing changed, any stitches removed and the stent in your kidney removed after four to six weeks.
We will be monitoring your blood pressure and will be changing your blood pressure tablets and immunosuppression during this time to get the balance of medication right.
You are normally able to drive about six weeks after your operation. We do not suggest driving before this point to reduce the risk of damage to the wound.
You should check with your insurance company and inform the DVLA that you have had a transplant.
Our aim is to allow each transplant patient to return to an independent lifestyle with a good quality of life.
Most people remain off work for two to three months after the transplant, but this depends on the individual patient and their occupation.
Please discuss when you can return to work with the doctor caring for you.
There is no special diet after successful transplantation and most of the dialysis dietary restrictions are lifted.
We would suggest that you follow a healthy and varied diet after transplantation with a low salt intake and more fruit and vegetables.
You can drink alcohol after the transplant, but only in moderation within the national guidelines of 14 units per week.
We ask you to avoid grapefruit juice and Seville oranges, which are found predominantly in marmalades, as this can affect the level of some of the immunosuppression tablets.
If you need further advice, please ask your doctor or specialist nurse to refer you to a dietician.
Weight gain is common after successful transplant, particularly within the first year, and is often due to an increase in appetite and steroid immunosuppression.
Weight gain will increase blood pressure and your risk of diabetes after the transplant. It is important to maintain a healthy diet and perform regular exercise to keep your weight within the healthy range.
It is not advisable to consider pregnancy within the first year post-transplantation.
Transplant patients of childbearing age should make sure they have adequate contraception following transplantation. Should you wish to take the oral contraceptive pill, discuss this at your outpatient appointment.
If you do wish to get pregnant after the first year, you should discuss your this with your consultant, who can explain the risks and refer you on to our local transplant pregnancy service.
Some of the drugs you will be taking after the transplant are harmful to an unborn child and you should not try to become pregnant before your medication has been changed to a less harmful combination. The outcome of the pregnancy and the effect on your kidney depend on the function of your kidney and several other factors.
There is no reason to prevent you from travelling within the UK when you feel well enough, but you should contact one of the medical staff you see regularly in the transplant follow-up clinic for advice.
We do not recommend you travel overseas in the first six months post-transplantation.
One-year transplant survival
After one year, 96% of kidneys from deceased donors are still functioning well.
After one year, 100% of kidneys in living donor transplants are still functioning well.
Five-year transplant survival
After five years, 85% of kidneys from deceased donors are still functioning well.
After five years, 92% of kidneys in living donor transplants are still functioning well.
This information is courtesy of NHS Blood and Transplant. Cohorts for survival rate estimation: 1 year survival: 1/4/2017–31/03/2021; 5 year survival: 1/4/2013–31/3/2017.
There are both early and late complications from transplantation, as listed here. Despite these risks, most patients are likely to have a longer life with better quality after transplantation.
Your medication will change after your transplant with some tablets, such as phosphate binders and vitamin supplements, stopping and new tablets starting. We will give you a list of your new medication before you leave the hospital.
The most important new tablets you will be started on are called immunosuppressants. These tablets stop your immune system from rejecting the kidney and should be taken regularly every day you have a functioning transplant. Because these medications reduce your own natural immune system, you will also be given medication to prevent you getting some serious infections.
Initially you are likely to be on a combination of three medicines:
- Mycophenolate mofetil
If you do not take these medications as prescribed, it will result in rejection and the loss of your new kidney.
These drugs need to be finely tuned as too little may lead to rejection and too much may lead to infection. Early after the transplant the need for immunosuppression is high but this need lessens with time, so the drugs will be slowly reduced by your doctors. The level of some of these drugs (tacrolimus) have to be monitored in the blood. When you come to clinic, do not take your tablets until after you have had your blood taken. After the clinic, you may be telephoned to change the dose of the tablets you are taking or asked to return for further blood tests.
Immunosuppressants, like most medicines, can have some unwanted side effects. However, just because a medicine has the potential to cause adverse effects, it does not necessarily mean you will get them. All anti-rejection drugs will increase your risk of infection and some cancers.
The individual immunosuppressives may have their own side effects as follows:
Shaking of the hands, headaches, impaired vision, ‘pins and needles’, raised blood sugar levels (diabetes), hair loss and kidney damage at high levels of tacrolimus in the blood.
High blood pressure, increased or unusual hair growth, tender or swollen gums, shaking of the hands, raised blood sugar levels (diabetes) and kidney damage at high levels of ciclosporin in the blood.
Irritation of the gut lining, indigestion, increase in appetite, weight gain, rounded face, thinning skin and bones and raised blood sugar levels (diabetes).
Diarrhoea, bloating, heartburn, nausea and vomiting.
Please inform your doctor if you experience side effects — they may want to cut down the dose or give you an alternative. Do not stop or alter the dose yourself.
You may be asked to take the following:
- Co-trimoxazole — an antibiotic to reduce the risk of bacterial infection.
- Omeprazole — to protect the stomach against ulcers and heartburn.
- Nystatin mouth wash — to prevent fungal infections of the mouth.
- Heparin — for the first week after transplant heparin may be given to prevent blood clots.
Please also see advice here about vaccinations to protect you from COVID-19.
Some of the medicines you will be taking after your transplant are affected by, and do themselves, affect other medicines. Please discuss your current medication with the pharmacist if you need to buy ‘over the counter’ medicines for minor ailments. Your GP may wish to contact the transplant unit or renal ward before giving you any new prescription medicines.
If you have any concerns about any aspect of your medicines, please do not hesitate to ask. If you are taking either ciclosporin or tacrolimus the following drugs and food and drink may affect them. Your renal or transplant doctor should be informed before these drugs are used:
- St. Johns Wort
- Herbal medicines
- Grapefruit juice
- Seville oranges
Many other drugs also interact with your medication. If you or your doctor are unsure, please discuss with your renal or transplant doctor.
Grapefruit juice and Seville oranges
Grapefruit juice and certain marmalades taken with cyclosporin or tacrolimus can alter the levels of these drugs in your blood. It is probably best to avoid grapefruit juice but apple or orange juice is OK. For further advice speak to your renal or transplant doctor.