Frequently Asked Questions
For more than 33 years, The University of Toledo Medical Center has offered adult and pediatric kidney transplantation as one of the treatment options for end-stage renal disease. We understand the anxiety and concern facing patients and their families as they search for information about transplantation as a possible treatment option.
We hope the information provided below will help answer some of your questions regarding the evaluation and follow-up care for kidney transplantation. Questions frequently asked by kidney transplant patients:
- Am I a good candidate for a transplant?
- What are the advantages of a kidney transplant?
- How are potential patients evaluated for a transplant?
- Can I be excluded from receiving a new kidney?
- Is age a barrier to receiving a new kidney?
- What happens after I am accepted as a candidate for a transplant?
- Where does my new kidney organ come from?
- How are kidneys matched to the best recipient?
- What happens when a kidney is located for which I am a good match?
- Who will perform my surgery?
- Who are the members of the transplant team?
- How is the transplant performed?
- How successful are kidney transplant operations?
- What happens after the transplant?
- How will the doctors and nurses know that the kidney is functioning properly?
- What kind of follow-up care will I receive?
- What type of counseling is available for my family?
- What are the symptoms if my body starts rejecting the new kidney?
- Will I know the name of the donor of my cadaver kidney?
- How will my transplant operation be paid for?
- Will I have to take medications the rest of my life?
- How important is it that I take the medication?
- Will I have to follow a special diet?
Q. Am I a good candidate for a kidney transplant? If your kidneys are no longer performing properly because of end-stage renal disease or chronic renal insufficiency and you are on dialysis, you are a prime candidate. Your primary care physician or nephrologist can assess your condition and advise you on a course of action. Back to Top
Q. What are the advantages of a kidney transplant? For many patients with end-stage renal disease, transplantation offers many advantages including freedom from dialysis, diet and fluid restriction. Kidney transplant patients enjoy an improved quality of life and are able to perform most, if not all, of the activities they enjoyed before the onset of kidney disease @ work, exercise and recreational activities. Back to Top
Q. How are potential patients evaluated for a transplant? Great care is taken in selecting those individuals who will benefit significantly from a kidney transplant. After referrals from their primary care physician or nephrologist, patients undergo outpatient medical evaluations to see if they are healthy enough to have surgery and free from cancer and serious infection. Patients are also evaluated to make sure they are able to following instructions and are willing to take medications as prescribed. A psychological assessment will be done to determine your understanding of the benefits and risks of the procedure, to predict your capability of being compliant to the medication regimen, and your ability to following the directions of the physicians and nurses to keep the transplanted kidney healthy and functioning.
Pre-transplant evaluations include blood tests, a skin test for tuberculosis and a dental evaluation. Depending on your age and medical condition, the transplant surgeon will order further tests as necessary. Back to Top
Q. Can I be excluded from receiving a new kidney? While the criteria for exclusion are not definitive in most instances, there are some general parameters that surgeons follow that exclude some patients. Physicians may find medical or psychological reasons that prohibit patients from receiving a new kidney, including the presence of HIV and/or AIDS, metastatic carcinoma, active infectious diseases (such as tuberculosis) and mental psychosis that is not treatable. Other reasons could be unstable cardiac conditions that need correction, a treatable and reversible infectious disease, and treatable and curable cancer. Back to Top
Q. Is age a barrier to receiving a new kidney? No, absolute age is not a factor. A patient's physical condition is more important. There have been many successful transplants performed on individuals in their 60s and 70s. Back to Top
Q. What happens after I am accepted as a candidate for a transplant? Patients accepted for transplantation are placed on the transplant waiting list and information about their care is shared with the referring physician and your dialysis unit. All transplant candidates are registered nationally with the United Network for Organ Sharing (UNOS) and with the local procurement agency, Life Connection. Back to Top
Q. Where does my new kidney organ come from? The best donor is a living relative or friend. This makes the procedure more convenient and statistics show that these kind of transplants are usually the most successful. This is becoming more common because of the success of the procedure and the shortage of cadaver organs. Living donations allow the immediate transplantation of kidneys into recipients once a suitable living donor has been identified and the long waiting times associated with cadaver donations are avoided. Cadaver donors are, however, the most common source of organs and have resulted in a large number of successful transplants. Back to Top
Q. How are kidneys matched to the best recipient? When it is decided that a living donor transplant is not possible for someone who wishes to have a kidney transplant, then the process of obtaining a cadaver kidney begins. A cadaver kidney is one that has come from someone who has recently died and whose family has consented to kidney donation. The UTMC kidney transplant program participates in a national computer network, the United Network for Organ Sharing (UNOS) that matches recipients and cadaver kidneys. Life Connection of Ohio is the local organ procurement agency. Each time a kidney becomes available, its blood type and tissue type are entered into the computer and matched with the best possible recipient. The goal is to provide the best possible match between kidneys and recipients regardless of location. As a result, a donor kidney for transplantation at UTMC can come from Ohio or any other state.
Tissue typing (the analysis of a sample of blood for markers on the white blood cells called antigens) is performed. The antigens are used to match a donated kidney with a potential recipient. In addition to matching donated kidneys to recipients by tissue typing, blood types must also be compatible. Back to Top
Q. What happens when a kidney is located for which I am a good match? When a donated kidney matches a person on the UTMC waiting list, Life Connection of Ohio (the local organ procurement organization) is notified. The organ bank is ready to receive calls 24 hours a day, seven days a week. When a call comes in that a kidney is available, the transplant team is notified. Because the call for a kidney may come at any time of the day or night and because an immediate answer is necessary in order to obtain the kidney, a person on a waiting list must have his mind made up that he is ready for a transplant and must be in good shape.
You will be called by the organ procurement organization coordinator informing you that a new kidney may be available. You will be instructed not to take any more food or fluids by mouth and to come to the University of Toledo Medical Center. You will immediately have your blood drawn for the tissue-typing cross match.
Since it takes anywhere from six to eight hours for the test results, a patient usually brings reading material or something else to pass the time. In most cases, more than one person is called in for each available kidney to give us the best opportunity to use the kidney in the least possible time. We like to transplant donated kidneys before they are 48 hours old and in some cases, transport of the kidney from another part of the country can take as long as 24 hours. Back to Top
Q. Who will perform my surgery? Your surgery will be performed by a highly experienced team of transplant specialists that includes surgeons, nephrologists, and nurses. Collectively, UTMC's kidney transplant surgeons have more than 90 years of experience. Back to Top
Q. Who are the members of the transplant team? The University of Toledo Medical Center transplant team includes nephrologists (a physician who specializes in the kidney), transplant surgeons, transplant coordinators, dietitians, pharmacists, social workers and a financial counselor. Back to Top
Q. How is the transplant performed? Kidney transplant operations are performed with the most advanced techniques. It generally takes four to six hours under general anesthetic to complete. A small incision about eight inches long is made in the lower right or left side of the abdomen for the transplant. The new kidney is attached to the major blood vessels. The vessels supply the new kidney with blood, which often results in the immediate production of urine. The ureter that carries urine from the new kidney is attached to your bladder. The transplant is then complete and your abdomen is closed. Removing your nonfunctioning kidney is usually not necessary unless there is a special medical reason to do so. Back to Top
Q. How successful are kidney transplant operations? Breakthroughs in the last 20 years in surgical skills, immunosuppressive drugs and tissue typing have all translated directly into long-term success rates. While all surgery is risky, experience has shown where the kidney donor is a relative; the donor kidney will be functioning two years after the time of the transplant 95 percent of the time. The chance of a cadaver transplant continuing to work over one year after the transplant is about 85% and about 50% at five years. However, both living donor and cadaver transplants can function for many more years. The loss of function occurs most often during the first two years. Therefore a transplanted kidney that is working well two years after a transplant is more likely to continue to function for long periods of time. Research shows the success rate for a transplant where the kidney donor is a relative is 98% while a transplant where the donor is a cadaver is 85%. So the chances of success are high. Back to Top
Q. What happens after the transplant? After the transplant is completed, you will be taken to your room in the renal unit in the hospital. When you wake up, you will have an intravenous line, a bladder catheter, a small oxygen catheter in your nostrils and heart-monitoring leads attached to your chest.
Nurses experienced in kidney transplantation will closely monitor you during the first two days. You should be out of bed and eating by the next day, and you will be given medication to control organ rejection.
During this time, the nurses will keep accurate records of intake and output. They will encourage you to cough and breathe deeply and teach you to use the incentive spirometer every hour to keep your lungs clear. You will be weighted every morning and have blood work done. For the first 24 to 36 hours, visitors are limited to immediate family members only.
Before you are discharged, you will be taught everything you need to know about living with your new kidney. Because you are in the hospital a short time (most people are discharged in less than a week) your discharge teaching will begin immediately after surgery. We want you to feel comfortable with your new kidney and your new medications before you go home. As you get stronger, you will be able to exercise even more. After several months, you'll feel strong enough to return to all your normal activities with renewed vigor. Back to Top
Q. How will the doctors and nurses know that the kidney is functioning properly? A useful gauge to determine whether your kidney is functioning is blood testing and urine output. The output of your urine is variable during the first few weeks. Your new kidney may produce urine immediately and continue, produce urine immediately but stop in a few hours or not produce urine at all.
These episodes, however, are not indicative of the final prognosis. Many times a new kidney becomes swollen on the inside due to the handling and changes in temperature prior to surgery. As a result, the kidney temporarily cannot produce urine. When the swelling begins to subside, the urine output will increase. In the meantime, you may need dialysis. Don't be alarmed; this does not mean your kidney is not good. Back to Top
Q. What kind of follow-up care will I receive? People who have a kidney transplant at UTMC are seen in the hospital transplant clinic as an outpatient after they have been discharged from the hospital. For the first few weeks after the transplant, these visits are two or three times a week. After that, they are at least once a week. The intervals between visits will gradually lengthen, until you come to the clinic every two or three months.
When you come to the clinic, you will have blood samples drawn in the morning and wait until the results are available before you see the doctor. When the results are available, the doctor may change your medication based upon your results. Anti-rejection medications are controlled and monitored by the surgical team.
Patients are routinely seen for the rest of their lives on a biannual basis, both for reporting purposes and to assess the adequacy of their treatment. Back to Top
Q. What type of counseling is available for my family? Because kidney transplant operations are both complex and are a family affair, patients and members of their families need intensive instruction and education so that the new kidney remains healthy. Family members are intimately involved in the care process, including decision-making and follow-up lifestyle changes. The kidney transplant coordinator instructs patients and their families concerning medications and encourages needed lifestyle changes. The coordinators are available 24 hours a day to answer questions and serve as a liaison between patients, referring physicians and the kidney transplant team. Back to Top
Q. What are they symptoms if my body starts rejecting the new kidney? Rejection can cause various symptoms and not all people react the same way. It may cause changes in your urine and blood chemistries, sudden weight gain, increase in blood pressure, headaches, fever, decreased urine output, a tender or swollen kidney, increased swelling of hands and feel, and a vague feeling of a loss of well-being. Rejection episodes are identified by doing blood chemistries along with ultrasound and renogram/renal scans of the transplanted kidney. Sometimes a biopsy is necessary. Episodes are treated with medications aimed at preventing and combating rejection of your kidney. Back to Top
Q. Will I know the name of the donor of my cadaver kidney? You will not know the name of the donor of a cadaver kidney. The family of the donor will not be told your name by anyone in the transplant program. These rules are strictly enforced to maintain the privacy of both the donor family and the transplant recipient. Back to Top
Q. How will my transplant operation be paid for? A kidney transplant is expensive. Fortunately, the kidney transplant program is approved by Medicare, and Medicare usually pays for most of the surgery and follow-up medications. Additional sources of payment include private insurance and the patient's personal funds. Our transplant social worker and financial coordinator will work with you according to your individual situation. There are programs available to help pay for uncovered medical costs and other funding sources may be available for patients with special needs. Back to Top
Q. Will I have to take medications the rest of my life? Yes, medications like Prograf, Myfortic and steroids (which are called immunosuppressants) are used to protect donor organs from being attacked by your immune system. These medications need to be taken for as long as the new kidney functions. Transplant recipients also need to maintain lifelong follow-up with doctors. Before you leave the hospital, the transplant team will make certain that you fully understand what your medications are for, and how and when to take them. Back to Top
Q. How important is it that I take the medications? It is very important to take your medications exactly as your doctor prescribes them. Skipping a dose or stopping medication can have serious consequences and can even lead to rejection. If you are having problems with your medications, talk with your doctor or see the transplant coordinator. Don't make changes on your own. Back to Top
Q. Will I have to follow a special diet? In the weeks immediately following your transplantation, diet is especially important. It can help counteract side effects of the anti-rejections drugs you are taking. As your recuperation progresses and medication dosage is gradually reduced, your diet is less restricted. It is important to eat high-quality protein from animal sources such as eggs, meat, fish, poultry, milk and cheese. Complex carbohydrates such as fruits, grains and vegetables are a necessary part of your diet. Simple carbohydrates such as sugar, honey and sugary foods should be limited. Fats from oils, butter, fried foods and fatty foods should also be limited. A dietitian will help you manage your diet. Back to Top