AUA Summit - What is a Kidney Transplant?


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What is a Kidney Transplant?

A kidney transplant is one of the most common organ transplant surgeries performed today. In this surgery, kidneys that aren't working well are replaced by a kidney from a donor. Kidney transplants have been performed since the 1950s. This surgery is a lifesaving choice for thousands of patients with endstage kidney disease (kidney renal failure). If you have kidney failure and cannot have a transplant, dialysis can sustain life. Dialysis cleans the blood by removing waste products such as urea.

What Happens When Kidneys Fail?

Harmful waste builds up in the body, which leads to:

  • high blood pressure
  • fluid buildup (edema)
  • salts and acids in the blood getting out of balance
  • decreased red blood cells
  • weak bones

All of these can be harmful, even deadly, to the heart, brain and skeleton.

How Do the Kidneys Work?

The kidneys are fist-size organs that handle the body's fluid and chemical levels. They are found on both sides of the spine behind the liver, stomach, pancreas and bowels. Healthy kidneys clean waste from the blood and make urine. They keep elements in the blood (sodium, potassium and calcium) in balance. Kidneys also make hormones that control blood pressure and red blood cells.


There are many signs of kidney failure, such as:

  • swelling of the hands, feet and face (edema)
  • headaches (due to high blood pressure)
  • seizures
  • pale skin color (due to low iron)
  • coffee colored urine
  • chronic bad breath that cannot be freshened by brushing your teeth
  • depression
  • fatigue
  • itchy skin


Each year about 115,000 people in the U.S. are found to have endstage kidney disease. In 3 out of 4 people who have endstage kidney disease, it is caused by:

  • high blood sugar (diabetes)
  • high blood pressure
  • glomerulonephritis (scars in the kidneys' tiny filters)

Other risk factors are:

  • high blood pressure
  • hardening of the arteries
  • African-American or Native American background
  • obesity
  • older age
  • untreated strep infections
  • chronic kidney infections
  • lupus
  • bad diarrhea
  • kidney stones
  • long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen



The most common treatment for endstage kidney disease is dialysis. Dialysis removes waste, extra water and chemicals (like potassium, sodium, calcium and acid) from the body. The 2 types of dialysis are hemodialysis and peritoneal dialysis.

In hemodialysis, your bloodstream is joined to a kidney machine outside the body. Hemodialysis is most often done 3 times per week and each session takes about 4 hours.

Peritoneal dialysis is done through a tube in the belly. Dialysis will not cure kidney failure. But dialysis can replace the work of the kidneys, and help you feel better and live longer.

Kidney Transplant

About 30 out of 100 patients with kidney failure can have a kidney transplant. This surgery returns kidney function by replacing 2 failed kidneys with 1 healthy organ. About two-thirds of kidney transplants come from nonliving (deceased) donors. But family members, spouses (living, related donors) and friends (living, unrelated donors) can donate safely if tests show that the donor will have nearly normal kidney function after giving up 1 kidney.

A kidney transplant is most often placed in the lower belly without removing the failed kidneys. The artery and vein of the new kidney are joined to an artery and a vein in the pelvis next to your bladder. The ureter (the tube that drains urine from the kidney to the bladder) attached to the new kidney is joined to your bladder or to one of your ureters.

In a child, the blood vessels from a large adult kidney transplant are often joined to the child's aorta (the largest artery in the body) and inferior vena cava (the largest vein in the belly).

What to Expect

If You are the Donor:

  • You can leave the hospital 2 to 4 days after surgery.
  • If your kidney was removed with open surgery, you will have a single cut about 8 inches long. 
  • Laparoscopic surgery is done using thin tubes put into your body through small cuts. If your doctor used laparoscopic surgery, you will likely have 4 smaller cuts, with the largest about 4 inches long.

If You are Receiving the Donor Kidney:

  • You will have a catheter (a thin tube to allow urine to drain) in your bladder for a few days.
  • You will have an IV feeding tube through your arm or neck vein for a few days. 
  • You will likely be up, out of bed and walking within 24 hours.
  • You can likely leave the hospital within a week.
  • Urine often flows at once. But sometimes the new kidney does not work well right away, so you may need dialysis for a short time.


Nine out of 10 transplanted kidneys work well at the end of 1 year. About 4 out of 100 kidney transplants stop working each year after that. The kidney is always at risk for rejection, so it is vital to take all of your drugs as you are told by your health care provider. A kidney from a living donor has a better chance of lasting than one from a nonliving donor. The chance that kidney disease will come back in the transplant depends on the original cause of kidney failure.

  • In autosomal dominant polycystic kidney disease or other inherited disorders, disease does not come back.
  • In hemolytic uremic syndrome (a rare health problem marked by kidney failure), the return of kidney disease is likely. 
  • In rapidly progressive focal segmental glomerulosclerosis, scar tissue replaces the glomeruli, the kidney's tiny filters.

Frequently Asked Questions

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

No. Blood types do not have to be the same, just compatible. Markers or "antigens" on the surfaces of red blood cells decide blood type. If the donor and patient do not have compatible blood types, the kidney can be rejected right away.

  • A donor with O blood type (and sometimes A2 blood type) can donate a kidney to a patient with O, A, B or AB blood type.
  • Patients with A or B blood types are often limited to kidney transplants from donors with the same blood type or O blood type.

Antibodies are proteins made by the immune system that react to donor tissue. To prove that a donor's kidney is okay to use, blood samples from the donor and patient are mixed. If there is no reaction (negative cross-match), the donor's kidney is safe to use.

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

When an organ becomes available, a patient is chosen using a nationwide point system. This system is based on blood type, waiting time, tissue match and antibody levels. Children are given extra points. While some people get a kidney within a few months, the average patient waits about 4 years. In contrast, a living donor kidney transplant can be scheduled as soon as the donor and patient are ready. This makes a living donor transplant an excellent choice.

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

The chance that you inherited this disease is about 50%. This disease results in a buildup of benign cysts that wipe out the normal tissue in both kidneys. Signs like abdominal swelling, pain, bloody urine and frequent urinary tract infections (UTIs) may show up at any time, but they often start in middle age. High blood pressure and renal failure may result as the disease progresses. There is no way to preserve kidney function in autosomal dominant polycystic kidney disease. But dialysis or a kidney transplant can be used to treat the kidney failure.

Autosomal dominant polycystic kidney disease should not be confused with multiple simple cysts of the kidneys. These simple cysts are often the result of age and don't cause kidney failure.

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