Kidney transplant overview for patients

Overview

A kidney transplant is an operation where a healthy kidney from a donor is placed into your body to replace your failed kidneys. The new kidney takes over filtering waste from your blood.

Kidney transplants are one of the most common organ transplants worldwide. Thousands are performed each year, but the need for kidneys is still much higher than the number of donors.

Kidney transplants are for people with end-stage kidney disease (kidney failure) whose kidneys can no longer keep them healthy. This includes adults and sometimes children. It is most often needed by people with long-term conditions like diabetes or high blood pressure that damage the kidneys.

Symptoms

Common symptoms

• During kidney failure (before transplant): feeling very tired, swelling in legs or ankles, trouble concentrating, poor appetite, muscle cramps, dry or itchy skin, needing to urinate more often (especially at night).

Symptoms in children

• In children, kidney failure can cause poor growth, feeling unusually sleepy, vomiting, and not gaining weight as expected.

Symptoms in older adults

• Older adults may have more subtle symptoms like confusion, loss of appetite, or worsening of other health problems.

Causes

Main causes

• Kidney failure that leads to needing a transplant is most often caused by long-term conditions like diabetes, high blood pressure, or glomerulonephritis (inflammation of the kidney filters). Other causes include polycystic kidney disease and severe infections or blockages in the urinary tract.

Risk factors

• Having a chronic disease like diabetes or high blood pressure
• Family history of kidney disease
• Being of African, Caribbean, or South Asian descent (higher risk of diabetes-related kidney failure)
• Older age, though age itself is not the main cause

When to see a doctor

See a doctor urgently if:

• If you have kidney failure and are not yet on the transplant waiting list, talk to your kidney specialist about whether a transplant might be right for you.
• If you have already had a transplant and develop a fever, pain over the new kidney, or a big drop in urine output – seek urgent care.

Book a routine appointment if:

• If you have kidney disease and are not yet at the failure stage, see your doctor regularly to monitor your kidney function and discuss when to consider transplant.

Diagnosis

Transplant evaluation is a thorough check to see if you are healthy enough for surgery and likely to benefit from a new kidney. It includes medical tests, scans, and discussions with a team of specialists.

Tests that may be done

• Blood tests to check blood type, tissue type, and antibodies
• Heart tests like an ECG or echocardiogram
• Urine tests to see how much kidney function is left
• Imaging tests like an ultrasound of your kidneys and bladder
• Cancer screening (as recommended for your age and risk)

What to expect at your appointment

You will meet with a transplant coordinator, surgeon, social worker, and dietitian. They will explain the risks, benefits, and what life will be like after transplant. You may also have discussions about potential living donors. The entire process can take weeks to months.

Treatment

A kidney transplant is a major surgery, but it offers the best long-term outcome for many people with kidney failure. After transplant, you will need to take immunosuppressant medicines every day to prevent rejection. You will also need regular check-ups and blood tests for life.

Self-care at home

• Take all prescribed medicines exactly as directed – never skip doses.
• Avoid people who are sick, especially with viruses, because your immune system will be weaker.
• Practice good hand washing to prevent infections.
• Protect your skin from the sun – wear sunscreen and clothing because the medicines increase skin cancer risk.
• Keep a record of your temperature, urine output, and any new symptoms to report to your team.

Medical treatments

After transplant, you will stay on a combination of immunosuppressant drugs to stop your body from attacking the new kidney. These are usually a steroid, a calcineurin inhibitor, and an antiproliferative agent. Anti-rejection therapy is tailored to each person. You may also need medicines to control blood pressure, cholesterol, and blood sugar. Regular blood tests monitor drug levels and kidney function.

When is surgery considered?

The transplant surgery itself typically takes 3 to 4 hours. You will be under general anaesthesia (asleep). The surgeon places the new kidney in your lower belly and connects it to your blood vessels and bladder. Your own kidneys are usually left in place unless they are causing problems.

Living with this condition

Most people feel much better after a kidney transplant – they have more energy, no longer need dialysis, and can return to work, hobbies, and travel. However, you will need to manage a strict medicine schedule and attend frequent clinic visits, especially in the first year.

Lifestyle tips

• Take all medicines every day – use alarms or pill organisers.
• Avoid unprescribed medications, especially NSAIDs (like ibuprofen) which can harm the kidney.
• Do not smoke or use recreational drugs – they increase rejection and health risks.
• Maintain a healthy weight to protect the new kidney and reduce heart risk.
• Get regular check-ups and blood tests as scheduled.

Diet and exercise

After transplant, you can usually eat a more normal diet, but you may need to limit salt, sugar, and unhealthy fats. Your dietitian will give personalised advice. Regular exercise like walking, swimming, or cycling is encouraged, but avoid heavy lifting for several weeks after surgery.

Mental health and emotional wellbeing

Having a transplant can bring relief but also anxiety – worry about rejection, side effects of medicines, or guilt towards the donor. It is normal to have ups and downs. Talking to a counsellor, social worker, or joining a support group can help. If you feel very low or anxious, tell your transplant team.

Prevention

You cannot prevent the need for a kidney transplant if you already have kidney failure. But you can slow the progression of kidney disease by controlling blood pressure, blood sugar, and avoiding medications that damage the kidneys.

Vaccines

Before transplant, make sure your vaccinations are up to date. After transplant, live vaccines (like MMR, chickenpox, or flu nasal spray) are not safe because of your weakened immune system. You can have inactivated vaccines (like yearly flu shot or pneumococcal vaccine). Ask your transplant team about the best schedule.

Screening programmes

If you have kidney disease, regular screening of your kidney function (eGFR, urine protein) can help identify worsening early and allow you to prepare for treatment options like transplant.

Complications

If left untreated

• If a transplant fails or is rejected, you will need to go back on dialysis or consider another transplant.
• Immunosuppressant medicines increase risk of infections, certain cancers (especially skin cancer), and side effects like high blood pressure, diabetes, and weight gain.
• Surgery-related complications: bleeding, infection, blood clots, or injury to nearby organs.

Long-term outlook

Kidney transplants have excellent outcomes – most transplanted kidneys work well for many years. With good follow-up care and medicine adherence, many people live active, full lives. Advances in anti-rejection drugs and living donation continue to improve results. Your transplant team will help you manage any complications that arise.

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