Kidney Transplantation – Procedure, Risks & Aftercare

What is a Kidney Transplantation?

Kidney transplantation is a surgical procedure in which a functioning kidney from a donor is transferred to a recipient. It is the preferred treatment for end-stage renal disease (ESRD) and offers significantly better quality of life and longer life expectancy compared to long-term dialysis.

The transplanted kidney takes over the functions of the diseased kidneys: filtering waste products from the blood, regulating fluid balance, and producing important hormones.

Indications

A kidney transplant is generally recommended in cases of:

• End-stage chronic kidney disease (GFR below 15 ml/min)
• Dialysis dependency (haemodialysis or peritoneal dialysis)
• Diabetic nephropathy
• Glomerulonephritis
• Polycystic kidney disease
• Chronic inflammatory kidney conditions

Types of Kidney Transplantation

Living Donor Transplantation

In a living donor transplantation, a healthy relative or close person donates one of their two kidneys. This approach generally offers better long-term outcomes, as waiting times are shorter and the kidney can be transplanted in optimal condition.

Deceased Donor Transplantation

In a deceased donor transplantation, the kidney comes from a brain-dead donor. Waiting times for such a kidney can be several years. Allocation is managed by Eurotransplant, an international organ allocation organisation.

Surgical Procedure

The operation typically takes two to four hours and is performed under general anaesthesia. The donor kidney is usually placed in the pelvic area of the recipient, where it is connected to the local blood vessels and the ureter. In most cases, the diseased native kidneys remain in the body and are not removed unless they cause complications.

Immunosuppression After Transplantation

To prevent rejection, in which the immune system attacks the foreign kidney, transplant recipients must take immunosuppressive medications for the rest of their lives. Commonly used drugs include:

• Tacrolimus
• Mycophenolate mofetil
• Corticosteroids (e.g. prednisolone)
• Cyclosporine A

These medications suppress the immune response and reduce the risk of rejection, but they also increase vulnerability to infections.

Risks and Complications

As with any major surgical procedure, kidney transplantation carries potential risks and complications:

• Acute rejection: The immune system attacks the donor kidney.
• Chronic rejection: A slow, gradual loss of transplant function over months or years.
• Infections: Increased susceptibility to infections due to immunosuppression.
• Thrombosis: Blood clots in the blood vessels of the donor kidney.
• Delayed graft function: The kidney takes longer than expected to begin functioning.
• Malignancies: Long-term increased cancer risk due to immunosuppression.

Follow-Up Care and Long-Term Prognosis

Regular follow-up appointments are essential after transplantation. In the early phase, these take place several times a week, and later at longer intervals. Monitoring includes:

• Kidney function values (creatinine, GFR)
• Blood levels of immunosuppressive drugs
• Blood pressure and blood glucose
• Signs of rejection or infection

The long-term prognosis has improved considerably in recent decades. Kidneys from living donors function for an average of 15 to 20 years, while kidneys from deceased donors last approximately 10 to 15 years. Many patients are able to lead a largely normal life after a successful transplant.

References

1. Kasiske BL et al. - KDIGO Clinical Practice Guideline for the Care of Kidney Transplant Recipients. American Journal of Transplantation, 2009.
2. Eurotransplant International Foundation: Annual Report 2022. www.eurotransplant.org
3. Wolfe RA et al. - Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. New England Journal of Medicine, 1999.