Authors: Megan Anderson and Mary Aardal, Fall 2001
Conditions leading to the need for a transplant
Kidney transplants are the second most common transplant operation in the United States
with over 9,000 cases per year. Many patients may need a kidney transplant if their
kidneys are not working to full capacity or are unable to work at all. Conditions such as
diabetes mellitus, hypertension, glomerular nephritis, polycystic kidney disease, or many
other conditions may lead to end-stage renal disease resulting in the need for a kidney
Pretransplant Evaluation Tests
Several tests must be completed before a patient can be given a transplant. First, a full
physical exam is needed. The health of the recipient’s heart must also be tested. Blood is
tested to determine immune system function and the presence of any diseases. Blood
typing is necessary for donor organ compatibility. Several other tests are performed to be
sure there are no other diseases or conditions that may compromise the success of the
transplant. Once the tests are done and passed, patients are placed on the National
Recipient List which is maintained by the United Network for Organ Sharing (UNOS).
Kidney Donation Process
Donor kidneys come from three different sources: cadaveric donor, live related donor,
and live unrelated donor. A cadaveric donor kidney is one that comes from a person who
has just died. A live related donor kidney comes from a blood relative of the recipient. A
live unrelated donor kidney comes from someone who is not related to the person.
Typically, there is a 2 to 3 year waiting list for a cadaveric kidney. Each year 1 out of 20
people waiting for a new kidney dies from kidney disease while on dialysis. Thus,
receiving a kidney from a living donor is optimal. Transplants from a blood-related
donor are considered a slightly better risk than from a cadaveric donor. Between 80%
and 90% of transplanted kidneys are functioning two years after the operation from a
The donor must be free from disease or infection, or injury that affects the kidney. The
patient must have the same or a compatible blood type as the donor. Table 1 shows the
compatibility of each blood type.
Blood Type Can receive from Generally can donate a kidney to
O O O, A, B, AB
A A, O A, AB
B B, O B, AB
AB O, A, B, AB AB
Kidney Transplant Process
The patient will be under general anesthesia throughout the surgery, which lasts about 3
to 4 hours. An incision is made into the right or left side of the lower abdomen just above
the groin. The surgical team will place the donor kidney into the abdomen and connect
the kidney’s blood vessels to the recipient’s iliac artery and vein. The surgeons then
connect the ureter to the bladder. (See picture) The transplant is then complete and the
abdomen is closed. Removing the nonfunctioning kidney is usually not necessary unless
there is a special medical reason to do so. The recovery period averages one month with
the average hospital stay being one week.
Post Surgery Care
The donor kidney acts as a foreign object that your body’s protective immune system
may try to attack. Medications, such as prednisone and cyclosporine, are taken to prevent
this from happening and may be required to be taken for the rest of the patient’s life.
These drugs are classified as “anti-rejection” or “immunosuppressive” drugs. The most
common medications work by lowering inflammation, blocking the action of specific
white blood cells, and decrease white blood cell function. Common side effects of these
medications include: swelling, increased appetite, unwanted hair growth, weight gain,
tremors, and mood swings. It is also necessary to monitor vital signs and keep a record
of blood pressure, pulse, temperature, and weight.
Transplant Diet Therapy
A diet containing solid food is implemented by post-operative day 2 or 3. If the patient
has not eaten by 5 days after surgery, the patient may need enteral or parenteral nutrition
The diet prescription for the first 4 to 8 weeks is 1.3 to 1.5 g Pro/kg body weight and 30
to 35 kcals/kg of dry weight. After 6 to 8 weeks the protein recommendation is to
decrease to 1.0 g Pro/kg body weight and energy sufficient to maintain body weight. Fat
intake should never be more than 30% of total calories. Cholesterol should be less than
300 mg/day. After 8 weeks from surgery the goal of nutrition therapy is to combat the
side effects of immunosuppressive drugs and to ensure adequate intake. Fluids are
encouraged as well as calcium rich foods to prevent steroid medicated osteoporosis.
Kidney transplant recipients are at risk for nutrient deficiency or toxicity. Between 5 and
10% of transplant patients develop hyperglycemia and half of these may require insulin
therapy. Hypophosphatemia occurs in as many as 50% of post transplant patients. It is
usually managed by increasing high phosphorus foods and using oral phosphorus
supplementation. Sodium restriction may be advocated if edema or high blood pressure is
present. Hyperkalemia and hyperlipidemia often develops in transplant recipients due to
the immunosuppressive drugs. Supplements of certain nutrients may be needed and
should be based on each individual patient’s needs.
Exercise is important for taking care of the new kidney. Benefits include; improved
strength, better blood pressure control, lower cholesterol levels, better sleep, better
weight control, stronger bones and healthier body.
Rejection of the New Kidney
Several steps must be taken to ensure the transplant is successful. There are vascular,
cellular, immunologic, and nonimmunologic mechanisms that can lead to rejection.
However, the transplant team makes every effort to
prevent rejection. These efforts include: careful
matching, anti-rejection medications, and closely
monitoring the kidney in order to perform additional
treatments when necessary. The kidney recipient
plays a big role in preventing rejection. The patient should get regular checkups and lab
work done, monitor vital signs, and check with the doctor before taking any self-care
products. The patient must also follow doctor’s advice on how to avoid infections,
follow proper diet and exercise program, and take the anti-rejection drugs.
Rejection can happen at any time. The three kinds of rejection are hyperacute, acute, and
chronic rejection. The three types vary by how and when a rejection episode happens.
A hyperacute rejection happens very suddenly and unexpectedly and results in complete
failure of the transplanted kidney. Acute rejection is the most common kind and it
develops over a brief period of time. The risk of an acute rejection episode is greatest
during the first two to three months. Chronic rejection comes about gradually over time.
It often gets worse and sometimes eventually results in kidney transplant failure. Chronic
rejection usually occurs after the first year.
If a rejection episode starts there are a couple of options. The dosage of one or more of
the medications may be changed temporarily or a different anti-rejection drug may be
given. In most cases a kidney biopsy is needed to confirm that rejection is due to the
immune system rather than some other problem, such as an infection.
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Manual of clinical dietetics. Sixth edition. 2000.
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Virginia Mason (2001). Dietary requirements after transplant. Retrieved September 26, 2001 from the
World Wide Web, www.vmmc.org
WebMD (2001). Kidney transplant. Retrieved October 6, 2001 from the World Wide Web,