Kidney Transplant - Before, During & After

Before Kidney Transplant Surgery

All transplant candidates who are referred to our program undergo a comprehensive series of tests to determine whether they would be a suitable candidate for a transplant. If, upon completion of the screening process, it is determined that a patient is a suitable candidate, we will try to identify suitable living donors. If no such donor exists, we immediately will place the patient on a transplant waiting list and begin working with the New England Organ Bank (NEOB) team to find a donor who matches the recipient’s requirements – e.g., similar age, right blood type. Patients should be aware that this search could take many months.

Another life-saving option for candidates seeking a kidney transplant is the New England Program for Kidney Exchange (NEPKE), which provides services to candidates whose potential living donor is not a good biological "match" because of blood type incompatibility or cross-match incompatibility. This option is known as kidney exchange, kidney paired donation or kidney swap.

Transplant Recipient Evaluation

Once the commitment to have a transplant has been made, a thorough evaluation process will take place. This will enable us to learn more about the patient’s condition and give the patient an opportunity to learn more about our kidney transplant program. During the evaluation, our team will be looking for physical and/or psychosocial conditions that could affect the chances of having a successful transplant. They will perform a series of examinations, which may include:

• Medical history
• Physical exam
• Bladder evaluation
• X-rays
• Blood tests
• Heart tests
• Dental exam
• Social worker interview

After a candidate is accepted for transplantation, he or she will be listed on Brigham and Women’s Hospital Deceased Donor Kidney Transplant List and added to regional and national lists of the United Network for Organ Sharing (UNOS). The allocation of organs is based upon a point system which takes into account medical urgency, time on the waiting list and blood type compatibility.

During Kidney Transplant Surgery

The entire surgical procedure typically lasts from two to four hours. In most cases, neither of the patient’s kidneys – regardless of functionality – will be removed, as keeping the kidneys in place has been shown to lead to better outcomes. Therefore, the donated kidney typically will be placed slightly above one of the patient’s preexisting kidneys. (In the rare case that removing one or both of the patient’s kidneys could be advantageous, the nephrologist and/or surgeon will discuss this option with the patient.)

After Kidney Transplant Surgery - In the Hospital

Immediately after surgery, the kidney transplant recipient, in most cases, will be taken to a special floor staffed by personnel experienced in caring for kidney transplant patients, or, in some cases, to the intensive care unit (ICU) for a brief period of observation. The patient will remain in the hospital for a total of about five to seven days following surgery.

After the Hospital

Kidney function will need to be monitored closely for the first several months after a patient leaves the hospital. The frequency of a patient's visits to the clinic and the need for blood work depends on individual progress and will lessen as they recover. Risk for rejection and infection decreases with time, but is never completely gone. Follow-up visits will be more flexible when the wound is healed, kidney function is normal and medication dose is adequate. At this time, blood tests may be done at a location closer to the patient's home. Follow-up care will be managed by the local doctor and lab facility.

The kidney transplant team will continue to follow a patient's progress as long as they have their new kidney. We encourage patients to return to the Brigham and Women's Hospital Transplant Center for a yearly checkup.

Exercise and diet after transplant are very important factors in feeling healthy again. Post-transplant patients are encouraged to resume or begin a regular exercise plan when they leave the hospital. It is very unhealthy for a patient's new kidney and their general well-being to put on excessive weight. The most effective method of maintaining a desired weight is to limit calories and to exercise regularly. Exercise for transplant patients has been shown to increase endurance, increase muscle strength, enhance bone remodeling and reduce the need for anti-hypertension medication.

The hospital dietician will help devise meal plans that are both nutritious and low in calories. Diet is important in the total rehabilitation process and for maintaining good nutritional status throughout a patient's life with a new kidney.