Kidney Transplantation

Finding a match

A kidney donor can be living or deceased, related or not related to you. Your transplant team considers several factors when evaluating whether a donor kidney may be a good match for you.

Tests to determine whether a donated kidney may be suitable for you include:

• Blood typing. It’s preferable to get a kidney from a donor whose blood type matches or is compatible with your own.

  Transplants that involve a donor and recipient with incompatible blood types also are possible but require more medical care before and after transplant to reduce the risk of organ rejection. These transplants are known as ABO incompatible kidney transplants.

• Tissue typing. If your blood type is compatible, the next step is a tissue typing test called human leukocyte antigen (HLA) typing. This test compares genetic markers that increase the likelihood the transplanted kidney will last a long time. A good match means it’s less likely that your body will reject the organ.

• Crossmatch. The third and final matching test involves mixing a small sample of your blood with the donor’s blood in the lab. The test determines whether antibodies in your blood will react against specific antigens in the donor’s blood.

  A negative crossmatch means the bloods are compatible, and your body isn’t as likely to reject the donor kidney. Positive crossmatch kidney transplants also are possible but require more medical treatment before and after the transplant to reduce the risk of your antibodies reacting to the donor organ.

Other factors your transplant team may consider in finding the best donor kidney for you include matching age, kidney size and infection exposure.

You may be able to find a willing living kidney donor rather than waiting for a compatible kidney from a deceased donor.

Family members are often the most likely to be compatible living kidney donors. But successful living-donor transplants also are common with kidneys donated from people who are not related, such as friends, co-workers or faith community members.

Paired donation is another type of living kidney donation. Paired donation may be an option for you if an organ from a living donor isn’t compatible or doesn’t match well for other reasons. Rather than donating a kidney directly to you, your donor may give a kidney to someone who may be a better match. Then you receive a compatible kidney from that recipient’s donor.

In some cases, more than two pairs of donors and recipients may be linked with a living kidney donor who hasn’t named a specific person to receive the kidney, called a nondirected donor. The pairs form a donation chain, and several recipients benefit from the nondirected donor’s gift.

If a compatible living donor isn’t available, your name will be placed on a waiting list for a deceased-donor kidney. Because there are fewer available kidneys than there are people waiting for a transplant, the waiting list is growing. The waiting time for a deceased-donor kidney is usually a few years.

Whether you’re waiting for a donated kidney or your transplant surgery is already scheduled, work to stay healthy. Being healthy and as active as you’re able can make it more likely you’ll be ready for the transplant surgery when the time comes. It also may help speed your recovery from surgery. Work to:

• Take your medicines as prescribed.
• Follow your diet and exercise guidelines.
• Keep all appointments with your healthcare team.

Stay in touch with your transplant team and let your team know of any significant changes in your health. If you’re waiting for a donated kidney, make sure the transplant team knows how to reach you at all times. Keep your packed hospital bag ready and make plans for transportation to the transplant center.

Kidney transplants are performed with general anesthesia, so you’re not awake during the procedure. The surgical team monitors your heart rate, blood pressure and blood oxygen level throughout the procedure.

During the surgery:

• The surgeon makes an incision in the lower part of one side of the abdomen and places the new kidney into the body. Unless your own kidneys are causing complications such as high blood pressure, kidney stones, pain or infection, they are left in place.
• The blood vessels of the new kidney are attached to blood vessels in the lower part of the abdomen, just above one of your legs.
• The new kidney’s ureter — the tube that links the kidney to the bladder — is connected to the bladder.

After a kidney transplant, you can expect to:

• Spend several days to a week in the hospital. Healthcare professionals monitor your condition in the hospital’s transplant recovery area to watch for signs of complications.

  Your new kidney will make urine like your own kidneys did when they were healthy. Often this starts immediately. Sometimes it may take several days. You may need temporary dialysis until your new kidneys begin to work properly.

  Expect soreness or pain around the incision site while you’re healing. Most kidney transplant recipients can return to work and other regular activities within eight weeks after transplant. Avoid lifting objects weighing more than 10 pounds or exercising other than walking until the wound has healed. The wound usually heals within about six weeks after surgery.

• Have frequent checkups as you continue recovering. After you leave the hospital, close monitoring is necessary for a few weeks to check how well your new kidney is working and to make sure your body is not rejecting it.

  You may need to have blood tests several times a week and have your medicines adjusted in the weeks following your transplant. During this time, if you live in another town, you may need to make arrangements to stay near the transplant center.

• Take medicines for the rest of your life. You’ll take a number of medicines after your kidney transplant. Immunosuppressant medicines help keep your immune system from attacking and rejecting your new kidney. Other medicines help reduce the risk of other complications, such as infection, after your transplant.