How successful is kidney transplantation at the Royal Free?
One year transplant survival
After one year, 94% of kidneys from people who have died are still functioning well. After one year, 95% of kidneys in living donor transplants are still functioning well.
Five year transplant survival
After five years, 81% of kidneys from people who have died are still functioning well.
After five years, 87% of kidneys in living donor transplants are still functioning well.
Figures provided by UK Transplant (Data from 2003-2007).
There are both early and late complications from transplantation, as listed below. Despite these risks, most patients are likely to have a longer life with better quality after transplantation.
What are the common early complications?
The anti-rejection treatment that you must take following your transplant will mean that you will be more likely to develop infections. The risk is greater in the early stages after your transplant when the doses of the drugs are higher. The increased risk of infection covers all types of bugs from wound infections, chest infections and urine infections to more unusual, and occasionally life threatening viruses, bacteria and fungus.
Heart and blood vessel disease is more common in patients with kidney failure and we screen all potential transplant patients to reduce the risk of this complication. Despite this thorough screening, a transplant can put extra stress on the body and there is an increased risk of heart attacks and strokes during the operation and for a few months afterwards.
Diabetes (raised blood sugar)
Can occur as a side effect of the anti-rejection drugs. It is usually treated with a change in diet and/or tablets. Sometimes there is a need for insulin injections.
Is a rare complication following transplant (2% of transplants) when a clot forms in the vein or the artery of the new kidney. This means that the blood supply to the kidney will stop. If this happens you will have to go back to theatre and in most cases the kidney will have to be removed.
Occasionally a leak will occur where the ureter (urine drainage tube) from the transplanted kidney joins your bladder. This usually requires a return to theatre and an operation to have the leak repaired.
As with all major surgery there is a risk of internal bleeding. This may require a blood transfusion and a further operation or procedure to stop the bleeding.
Deep Venous Thrombosis (DVT)
Following all surgery there is a risk of clots forming in the veins of the leg. Under certain circumstances these clots can be dangerous and move to the lungs. To prevent this happening you will be given special stockings and may have a special pump put on your legs or have injections of heparin for the first few days following the transplant operation.
The transplant is situated in the groin where small vessels drain excess fluid from the leg. The fluid from the leg can accumulate in small collections in the groin or around the kidney. These do not normally require anything to be done about them but occasionally they will need to be drained with a needle or by an operation.
Damage or infection from the surgery
Wound infection can occur after transplantation and may be deep within the abdomen, requiring a further operation or procedure. Damage to the bowel and other local structures is uncommon (1%) but may require a further procedure or operation.
What are the long-term complications of transplantation?
This is a common problem after successful renal transplantation because of improved appetite and steroid treatment. Increasing weight can increase your risk of diabetes and high blood pressure. It can be minimised by eating a healthy diet and by taking regular exercise.
High blood pressure
This is very common following kidney transplantation because of the immunosuppressive drugs (mainly cyclosporin or tacrolimus), transplant function and pre-existing kidney disease. Many people require blood pressure lowering drugs long-term. Rarely, high blood pressure can be caused by a narrowing of the transplant artery.
This can develop for the first time following renal transplantation, as outlined above. Diabetes can increase the risk of heart and blood vessel disease as well as lead to some other complications.
Cholesterol levels and other blood fats
These can increase after a kidney transplant, principally as a side effect of drugs, with various other causes contributing. A healthy diet will help to reduce your cholesterol but cholesterol-lowering treatment may also be required.
Cardiovascular disease such as angina, heart attacks, circulatory problems and strokes are all more common in patients with kidney disease. Receiving a kidney transplant does reduce the risk, when compared to dialysis but it does not remove the risk completely. It is important to stop smoking and follow any advice on blood pressure, cholesterol and diabetes. Keeping your weight down and taking exercise regularly are also sensible measures.
Recurrence of the original disease which damaged your own kidneys
This is a recognised complication but an unusual cause of transplant failure. Some types of kidney disease are more likely to recur than others and you will be monitored closely for this problem. Occasionally a new form of kidney disease can develop in a transplant kidney.
This is more common in people with kidney transplants (roughly twice the rate of the general population) because of the immunosuppressive treatment and types of viral infection. Three of the most common types of tumours to develop are skin cancer, cervical cancer and lymphoma. Careful avoidance of sun exposure and use of powerful sun screens help reduce the risk of skin cancer. Women should also have cervical smears performed annually. Other types of tumours, such as lymphomas are seen more frequently in transplant patients compared with non transplanted patients.
It is clear that many of these side effects can be attributed to the immunosuppressive medication. Unfortunately without these drugs, the kidney transplant will fail. It is important to take your medication regularly without missing doses. Stopping your prescribed medication, or not taking it properly, is likely to lead to rejection and the possible loss of your transplant.
New drugs with fewer unwanted effects are continually under development and your therapy might change in the future. Despite the risk of complications, most patients are more likely to live longer and have a better quality of life with a transplant than having dialysis.