Download What You Need to Know about a Kidney Transplant

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What You Need to Know about a Kidney Transplant
This information will help you understand the
risks, benefits and possible complications involved
in a kidney transplant. Please read it carefully. Ask
questions about anything you do not understand.
Evaluation
Before you can have a kidney transplant, you must
be evaluated to see if:
• A kidney transplant is the right treatment for you.
• Another treatment besides a kidney transplant
could help you.
• You are well enough to have kidney transplant
surgery.
Testing
An evaluation for a kidney transplant involves many
tests. More tests may be needed based on the results
of these tests. As part of the evaluation, you may get
one or more of the following:
• Blood tests. These tests can help show:
– Your blood and tissue type, to help find a
matching donor kidney.
– Whether you have certain viruses, such as
hepatitis or HIV.
– How well your other organs are working.
(This may involve testing your urine as well.)
For informational purposes only. Not to replace the advice of your health care provider.
Copyright © 2010 Fairview Health Services. All rights reserved. SMARTworks 520644 – REV 03/16.
• A chest X-ray. This helps show any problems with
your lungs.
• Heart tests. An electrocardiogram (EKG) can
show if you have any heart rhythms that are not
normal. An echocardiogram uses sound waves to
look at how well your heart is working. A stress
test shows how well your heart works under
stress. These tests can help your doctors decide
if your heart is strong enough for transplant
surgery. They can also help your doctors decide
if another test, such as an angiogram, is needed.
(An angiogram tests to see if one of your blood
vessels is blocked.)
• Breathing tests. Breathing tests (called
pulmonary function tests) show how well your
lungs are working. They may be needed if you
have a history of smoking or lung disease.
Some patients may also need occasional urine tests
to screen for drugs.
Meetings with the transplant team
As part of the evaluation, you will also meet with
members of the transplant team, including:
• Transplant coordinator. The transplant
coordinator will explain the transplant and what
you will need to do before and afterwards. And
you will attend a class on kidney transplant.
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• Transplant surgeon. The transplant surgeon will
talk with you about whether a transplant is the
right treatment for you. The surgeon will discuss
the risks, benefits and possible complications of a
kidney transplant.
• Nephrologist (kidney doctor). A nephrologist
will give you a physical exam and review your
tests to make sure a transplant is right for you. A
nephrologist will also help care for you and your
new kidney after your transplant surgery.
• Social worker. A social worker will evaluate how
well you can cope with a transplant and follow a
treatment plan. The social worker will also help
you put together a support network.
• Financial coordinator. A financial coordinator
will talk with you about the cost of the transplant
and the medicines you will need. The financial
coordinator will help determine how much of
these costs your insurance will cover. All of your
costs may not be covered by insurance.
• Registered dietitian. A registered dietitian will
help make sure that you get proper nutrition
before, during and after the transplant.
Some patients may need to be referred to other
specialists—for example, a hepatologist (liver
doctor), a pulmonologist (lung doctor), a
cardiologist (heart doctor) or a psychologist.
Surgery
Most people have two kidneys. They are in the back
underneath the rib cage. The kidneys help remove
wastes and fluids from the body, make blood cells
and control blood pressure. The wastes and fluids
removed by the kidneys become urine, which flows
from the kidneys to the bladder through a tube
called the ureter.
Your new kidney will be put in the lower, front part
of your abdomen. During the surgery the donor
artery is attached to your artery, the donor vein
is attached to your vein, and the donor ureter is
attached to your bladder.
After the transplant, you will wake up with a curved
incision (cut) that is 6 to 8 inches long. You will also
have a tube in your bladder to measure how much
urine your new kidney is making.
Risks of surgery
• General anesthesia. The transplant surgery
will be done under general anesthesia. This
means that we will give you medicine to keep
you from waking up or feeling pain during the
surgery. There are risks with general anesthesia.
The doctor who will give you this medicine
(anesthesiologist) will explain these risks to you.
• Blood and blood products. If your blood count
is low, you may need blood before your surgery.
You may also need blood if there is bleeding
during or after surgery. Blood and blood products
can contain bacteria and viruses that can cause
infection. Such infections are rare but can include
human immunodeficiency virus (HIV), hepatitis
B (HBV) and hepatitis C (HCV), among others.
You will be asked to sign a separate consent form
for blood (transfusion) at the time of surgery.
• Complications. All surgeries have a risk of
complications. Transplant surgery, which is a
long operation (3 to 6 hours under anesthesia),
is no different. Many complications are minor
and get better on their own. But in some cases
the complications are serious enough to require
another surgery or even cause death. Patients
having any surgery can have a heart attack
or stroke or get pneumonia. Other possible
complications include:
– Blood clots in the legs. Even if compression
boots or stockings are used, blood clots can
form in the legs and move through the heart
to the lungs. In the lungs, the clots can affect
breathing, which can lead to death. Blood clots
can be treated with blood-thinning drugs.
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These drugs may need to be taken for a long
time after surgery.
– Problems with transplanted blood vessels. In a
kidney transplant, complications can occur
when the blood vessels are hooked up. The
vessels can bleed, requiring a transfusion
or another operation. Or a blood clot
(thrombosis) can form. Though this is rare,
clotting can cause the kidney transplant to fail.
Most patients who develop a clot in the kidney
will have to go back on dialysis and have
another kidney transplant.
– Urinary problems. Complications can also
occur when the ureter (the tube that carries
urine from the kidneys to the bladder) is
hooked up. These can include leaking and
narrowing (strictures). If this happens, we may
need to put tubes through your skin to help
you heal. In some cases, another surgery is
needed to fix the problem.
– Hernia. If the cut made during surgery
(incision) does not heal well, tissue can bulge
or stick out. This is called a hernia. More
surgery may be needed to fix this.
– Fluid around the kidney. Fluid can sometimes
collect around the kidney. This is called a
lymphocele, and it can affect how well the
kidney works. Sometimes, more surgery is
needed to fix this problem.
– Nerve damage. Although this rarely happens,
nerves may be damaged during surgery. Nerve
damage can cause numbness, weakness, an
inability to move (paralysis) or pain. In most
cases, these symptoms are temporary. But in
rare cases they can last for a long time or even
be permanent.
– Other rare but possible complications include
injury to the abdomen, sores on the skin
(pressure ulcers), burns caused by the use of
electrical equipment during surgery, damage to
arteries and veins, and permanent scarring at
the incision.
– The doctors and nurses will watch you very
closely after surgery. They will look for
problems with bleeding, urine flow, blood
flow to the kidney and healing. If a problem
develops, you may need to go back into surgery.
Many patients ask whether they can die from
a kidney transplant. The answer is yes. As with
any surgery, complications can develop. Most
deaths, however, are caused by other medical
problems, such as heart disease, diabetes and
high blood pressure.
• Rejection. After your transplant, your body will
try to reject your new organ. This is normal. You
must take anti-rejection medicine and keep all
appointments to lower the risk that your body
will reject the new organ. The risk of rejection
never goes away. We will talk with you about the
signs and symptoms of rejection while you are
in the hospital. If your kidney stops working
because you do not take your anti-rejection
medication, you may not be considered for
another transplant.
• High blood pressure, diabetes and high
cholesterol. Anti-rejection medicines sometimes
can cause high blood pressure, diabetes or
high cholesterol. Patients often say, “I already
have high blood pressure, diabetes, and high
cholesterol. What does this mean for me?” It may
mean that your medicines will be changed. If you
have diabetes and have not taken insulin before
the transplant, you may need to do so afterwards.
• Infection. The risk of infection is higher for
transplant than for other surgeries because
the medicine needed to keep your body from
rejecting your new organ makes it harder for you
to fight off an infection. Also, kidney disease itself
makes you less able to fight infection. Infections
from bacteria, viruses or funguses are all possible.
• Cancer. Transplant patients have higher risk of
getting some cancers because of the anti-rejection
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drugs. These include skin cancer, lymphoma and
(in women) cancer of the cervix.
• Slow or delayed kidney. Sometimes a kidney
doesn’t work right after it has been transplanted.
This is called delayed kidney function. It happens
in about 2 of 10 transplants. It happens because
the new kidney is outside the body for a period
of time after it is removed from the donor. If your
new kidney doesn’t work right away, you may
need dialysis during the time that the new kidney
is not working. This does not mean the new
kidney is failing. It nearly always starts working.
The time it takes to begin working may be as
short as a couple of days or as long as a few weeks.
• Recurrence of kidney disease. Some kidney
diseases can return in the new kidney. If this is a
concern for you, we can talk about this with you
when we meet.
• Psychological and social problems. A serious
illness can stress you and your family. It is
important that you choose one or more people
to support you before, during and after your
surgery. Your supporter(s) will help you with
such things as taking medicines and getting to
appointments. If you are from out of town, you
will need to stay in the area for a while after you
get out of the hospital. After your transplant,
there will be many ups and downs in both your
physical and emotional condition. Some patients
will experience depression, post-traumatic stress
disorder (PTSD), anxiety and other problems.
Tell us if you think you may be having any
psychological side effects.
• Risks related to the donor. The success of your
kidney transplant can be affected by the donor’s
history and the condition of the organ when it
is received in the operating room. There is also
a risk that you may contract HIV and other
infectious diseases if they cannot be detected in
the donor.
Benefits of surgery
A transplant is a good option for many patients.
Some of the possible benefits include:
• Longer life. Studies show that patients carefully
selected for transplant tend to live longer than
those who stay on dialysis. Dialysis removes
wastes only during treatment. A transplanted
kidney removes wastes 24 hours a day, 7 days
a week.
• Better quality of life. A transplant can improve
your quality of life. For most patients, this means
freedom to do things they enjoy and the ability
to return to work. This freedom comes with
responsibility, though—to take medicines as
directed, maintain a healthy lifestyle, go to all
appointments and complete all blood work.
Is a transplant right for you?
A transplant may not be the right option for every
patient. If we feel that it is too dangerous for you to
have a transplant, we will let you know, and you will
stay on dialysis. If you do not want to take the risks
of surgery and anti-rejection treatment, you can
continue with dialysis as you are doing now. If you
haven’t decided yet whether a transplant is right for
you, you can still go on the waiting list. Later, if you
choose not to have the transplant, you can take your
name off the list.
Right to refuse transplant
You have the choice not to have a transplant. If you
choose not to have a transplant, treatment for your
kidney disease will continue.
Other treatments
There may be other ways to treat your condition.
Please talk about this with your health care team.
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National and transplant center-specific
outcomes
We have given you data on our most recent
outcomes for kidney transplantation as released
by the Scientific Registry of Transplant Recipients
(SRTR). Our results meet or exceed SRTR standards
and do not differ significantly from expected
survival rates. For more information, go to
www.ustransplant.org.
Notification of Medicare outcome
requirements not being met
Transplant centers must meet certain outcomes.
We have to notify you if we do not meet these
requirements. Currently, the University of
Minnesota Medical Center meets all requirements
for transplant centers.
Transplantation by a transplant center not
approved by Medicare
Having your transplant at a facility not approved by
Medicare may affect whether Medicare Part B will
pay for your anti-rejection drugs.
Insurance coverage after a transplant
After you have a kidney transplant, health insurance
companies may consider you to have a pre-existing
condition and refuse payment for medical care,
treatments or procedures. After the surgery, your
health insurance and life insurance premiums may
go up and stay up. Insurance companies may refuse
to insure you.
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