Health A to Z
A kidney transplant is the transfer of a healthy kidney from one person into the body of a person who has little or no kidney function.
The main role of the kidneys is to filter waste products from the blood and convert them to urine. If the kidneys lose this ability, waste products can build up, which is potentially life-threatening.
This loss of kidney function, known as end-stage chronic kidney disease or kidney failure, is the most common reason for needing a kidney transplant.
It's possible to partially replicate the functions of the kidney using a blood filtering procedure known as dialysis. However, this can be inconvenient and time-consuming, so a kidney transplant is the treatment of choice for kidney failure whenever possible.
Most people who need a kidney transplant are able to have one, regardless of their age, as long as:
Reasons why it may not be safe or effective to perform a transplant include having an ongoing infection (this will need to be treated first), severe heart disease, cancer that has spread to several places in your body, or AIDS.
Around one in three people with kidney failure is suitable for a transplant.
Unlike many other types of organ donation, it's possible to donate a kidney while you're alive because you only need one kidney to survive. This is known as a living donation.
People who want to be considered as a kidney donor are tested very carefully to ensure they are a suitable donor and are fit for the operation needed to remove a kidney.
Ideally, living donations will come from a close relative because they are more likely to share the same tissue type and blood group as the recipient, which reduces the risk of the body rejecting the kidney.
Kidney donations are also possible from people who have recently died. This is known as deceased kidney donation. However, this type of kidney donation has a slightly lower chance of long-term success.
Read more about donating a kidney.
People who need a kidney transplant, but don't have a suitable living donor, will have to wait until a suitable deceased donor kidney becomes available.
On average, the waiting time for a deceased donor kidney transplant is two to three years. Waiting times are so long because the demand for donated kidneys in the UK is far higher than the available supply of donors.
From April 2014 to April 2015, around 3,000 kidney transplants were carried out in the UK, but there were still more than 5,000 people on the waiting list for a kidney by the end of this period.
Kidney donors are particularly required from people of non-white ethnic origin, because rates of kidney disease are especially high in people of South Asian, African and Caribbean ethnic origin. However, there are not many donors from these communities.
Read more about the kidney transplant waiting list.
If you receive a kidney from a living donor, this will be a carefully planned operation.
If you're waiting for a deceased donor kidney, the transplant centre will contact you when a suitable kidney becomes available. This can happen at any time of the day or night. Staff at the centre will check you don't have any new medical problems and will ask you to go to the centre, where final checks will be performed to be sure the transplant should go ahead.
You'll then have surgery to insert the new kidney and connect it to your blood vessels and bladder. The new kidney will be placed in the lower part of your abdomen (tummy). Your own kidneys will usually be left in place.
A kidney transplant is a major surgical procedure with a wide range of potential risks. In the short term, these risks include blood clots and infection. Longer-term problems, which include diabetes and an increased risk of infections, are usually related to the medication you need to take to reduce the chance of rejection.
Because of the risk of further problems, people who have had a kidney transplant require regular check-ups for the rest of their life.
Having a healthy lifestyle after a kidney transplant goes a long way to minimise the risk of complications.
Therefore, it’s recommended that you:
Read more about living with a transplant.
There are a number of factors which affect how long a transplanted kidney lasts.
These include whether or not the kidney came from a living donor, how well the kidney is matched in terms of blood group and tissue type, and the age and overall health of the person receiving the donation.
Overall, average kidney survival times are:
If you have a kidney transplant that fails, you can usually be put on the waiting list for another transplant. You may need dialysis in the meantime.
Ideally, a kidney transplant should be performed when tests show that the extent of damage to your kidneys is so great that you'll need dialysis within the next six months.
However, because of the lack of available kidneys, it's unlikely you'll receive a kidney donation at this time, unless a family member or friend who has a similar tissue type is willing to make a living donation.
Most people with kidney failure need dialysis while they wait for a donated kidney to become available.
The average time a person spends on the waiting list for a kidney transplant is two to three years, although it can be shorter or longer than this.
Demand for donations from recently deceased people far outstrips supply, so there are strict but necessary guidelines about how donations are allocated.
Children and young adults are generally given priority if a matched donation becomes available, as they'll most likely gain a longer-term benefit from a transplant.
For older adults, a scoring system is used to determine who should get a donation. The score is based on factors such as how long you've been on the waiting list and how well matched the donor is in terms of tissue type, blood group and age.
If you're on the waiting list for a kidney, the transplant centre will need to contact you at short notice once a kidney becomes available, so you must inform staff if there are any changes to your contact details.
You should also inform staff if there are changes to your health – for example, if you develop an infection.
While waiting for a donated kidney to become available, it's important to stay as healthy as possible by:
Make sure you always have an overnight bag ready for when the call comes, and make arrangements with friends, family and work so you can go to the transplant centre as soon as a donor kidney becomes available.
In England, there are 20 NHS specialist kidney transplant centres. Six centres are in London, and a further 14 are in the following cities:
Read about what happens during a kidney transplant.
When a suitable donor kidney is found, the transplant centre will contact you. Staff at the centre will check you don't have any new medical problems and then ask you to go to the centre.
When you hear from the transplant centre:
When you arrive at the transplant centre, you'll be quickly assessed. Some of the tests you had at your initial assessment may be repeated to ensure no new medical conditions have developed. Tests will also be done to ensure the donor kidney is suitable for you.
The transplant procedure must be carried out as quickly as possible for the transplant to have the best chance of success. After the medical team has confirmed the kidney is in good condition and is suitable, you'll be given the general anaesthetic and taken to the operating theatre.
The kidney transplant procedure involves three main stages:
A small plastic tube called a stent may be inserted into the ureter to help ensure a good flow of urine initially. This will usually be removed about 6 to 12 weeks later during a minor procedure called a cystoscopy.
When the kidney is properly in place, the incision in your abdomen will be closed with surgical staples, stitches or surgical glue.
Although the procedure may sound relatively straightforward, it's very demanding and complex surgery that usually takes around three hours to complete.
Once you've recovered from the effects of the anaesthetic, it's likely you will feel some pain at the site of the incision. Painkillers will be provided, if necessary.
After the operation, you'll immediately begin treatment with medication designed to prevent your immune system from rejecting your new kidney. See living with a kidney transplant for more information on this.
Most transplanted kidneys will start working immediately, particularly if they come from a living donor, although sometimes they may take a few days or weeks to work properly. If this is the case, you'll need to have dialysis during this time.
Most people can leave hospital in about a week, but you'll need to attend frequent appointments at the transplant centre, so your kidney function can be assessed and tests can be carried out to check how well your medications are working.
For the first few weeks after surgery, you may need to have two to three appointments a week. However, over time, your appointments will become less frequent. After a year, as long as you do not have any serious problems, you should only have to attend the centre once every few months.
After kidney surgery, you should be able to return to work and normal activities within a few months, provided you make good progress.
The following lifestyle advice is usually recommended to help you stay healthy after a kidney transplant.
If you smoke, it's strongly recommended that you stop as soon as possible because smoking can reduce the life of your new kidney and can increase your risk of developing some types of cancer.
Most people are able to enjoy a much more varied diet after a kidney transplant, although you may be advised to avoid some foods after the operation until the kidney is working properly.
During the early stages after a transplant, while you're on higher doses of immunosuppressant medication (see below), you should avoid eating foods that carry a high risk of food poisoning, including:
Once your kidney is working properly and the best immunosuppressant dose for you has been identified, you'll usually be advised to follow a generally healthy diet, as this can reduce your risk of complications such as diabetes.
Read more about the risks of a kidney transplant.
A healthy diet should include:
Once you've started to recover from the effects of surgery, you should try to do regular physical activity.
Adults should do at least 150 minutes (2 hours and 30 minutes) of moderate-intensity exercise every week. This includes any activity that increases your heart and breathing rate – it may make you sweat, but are still able to hold a normal conversation.
Choose physical activities that you enjoy, as you're more likely to continue doing them.
It's unrealistic to meet these exercise targets immediately if you have not exercised much in the past. You should aim to start gradually and then build on it.
If you're overweight or obese, you should try to achieve a healthy weight. This can be safely done through a combination of eating a healthy, calorie-controlled diet and regular exercise. Aim for a body mass index (BMI) of 18.5 to 25.
Regularly drinking alcohol above the maximum recommended limits can raise your blood pressure, which can be dangerous for people with a kidney transplant.
Alcohol is also high in calories, so you'll gain weight if you drink regularly. Being overweight will also increase your blood pressure. Read more about the calories in alcohol.
You should also avoid taking any illegal drugs after a kidney transplant, as they can damage your kidneys, cause a sudden rise in blood pressure and react unpredictably with your immunosuppressant medications.
Finally, always check with your care team before taking any medication, including over-the-counter medication and herbal remedies such as St John's wort. Some medications could be potentially harmful if you have had a kidney transplant and are taking immunosuppressant medication.
If you have a kidney transplant, you'll usually need to take immunosuppressant medications for the rest of your life to prevent your body's immune system from attacking the new kidney.
Widely used immunosuppressants include tacrolimus, ciclosporin, azathioprine, mycophenolate, prednisolone and sirolimus.
However, taking immunosuppressive medications on a long-term basis will weaken your immune system and make you more vulnerable to infections, so you'll need to take extra precautions against infection:
Make sure your vaccinations are up to date, although you won't be able to have any vaccines that contain live viruses, such as the measles, mumps and rubella (MMR) vaccine.
If you think you may have an infection, contact your GP or transplant centre for advice. Prompt treatment may be required to prevent serious complications developing.
Symptoms of infection can include:
Although rates of serious complications have fallen sharply in the last few decades, kidney transplants – like any other type of surgery – are not risk-free.
The risks of a kidney transplant include:
Most complications occur in the first few months after a transplant, but can develop after many years.
Some of the main short-term and long-term complications of a kidney transplant are outlined below.
Blood clots can develop in the arteries that have been connected to the donated kidney. This is estimated to occur in around 1 in 100 kidney transplants.
In some cases, it may be possible to dissolve the blood clots using medication, but it's often necessary to remove the donated kidney if the blood supply is blocked.
Narrowing of the artery connected to the donated kidney, known as arterial stenosis, can sometimes occur after a kidney transplant. In some cases, it can develop months, or even years, after the transplant.
Arterial stenosis can cause a rise in blood pressure. The artery often needs to be stretched to widen it, and a small metal tube called a stent may be placed inside the affected artery to stop it narrowing again.
The ureter (the tube that carries urine from the kidney to the bladder) can become blocked after a kidney transplant. It can be blocked soon after the transplant – by blood clots, for example. It can also be blocked months or years later, usually due to scar tissue.
It may be possible to unblock the ureter by draining it with a small tube called a catheter. Sometimes surgery may be required to unblock the ureter.
Occasionally, urine may leak from where the ureter joins the bladder after surgery. This usually occurs during the first month after the procedure. The fluid may build up in the tummy or leak through the surgical incision.
If you develop a urine leak, you'll usually need to have further surgery to repair it.
Acute rejection means the immune system suddenly begins to attack the donated kidney because it recognises it as foreign tissue.
Despite the use of immunosuppressants, acute rejection is a common complication in the first year after a transplant, affecting up to one in three people.
In many cases, acute rejection does not cause noticeable symptoms, and is only detected by a blood test.
If it does occur, it can often be successfully treated with a short course of more powerful immunosuppressants.
Immunosuppressants prevent your body's immune system from attacking the new kidney, which would cause the transplanted kidney to be rejected.
A combination of two or three different immunosuppressants is usually taken long term.
These can cause a wide range of side effects, including:
The doctor in charge of your care will be trying to find the right dose that is high enough to "dampen" the immune system to stop rejection, but low enough that you experience very few or no side effects.
Finding the optimal dose to achieve both goals is often a difficult balancing act. It may take several months to find the most effective dose that causes the least amount of side effects.
Side effects should improve once the right dosage is identified. Even if your side effects become troublesome, never suddenly stop taking your medication because your kidney could be rejected. Speak to your GP or transplant team for advice.
Diabetes is a common complication of having a kidney transplant.
Diabetes is a lifelong condition that causes a person's blood sugar level to become too high. Some people develop it after a kidney transplant because, as they no longer feel unwell, they eat more and gain too much weight. Some types of immunosuppressants can also make you more likely to develop diabetes.
Symptoms of diabetes include:
Diabetes can often be controlled using a combination of lifestyle changes, such as alterations to your diet, and medication.
Read more about treating diabetes.
High blood pressure is also a common long-term complication of a kidney transplant.
Many people who need a kidney transplant already have an increased risk of developing high blood pressure, and taking immunosuppressants can make the condition worse.
Because of the risk of high blood pressure, you'll have your blood pressure checked at your follow-up appointments. You can also check your own blood pressure at home with a simple device available from most pharmacies. Read more about testing your blood pressure.
The long-term use of immunosuppressants also increases your risk of developing some types of cancer, particularly types known to be caused by viruses (as you will be more vulnerable to the effects of infection).
You can reduce your risk of skin cancer by avoiding exposure to the sun during the hottest part of the day and by applying sun cream to your lips and all exposed areas of your skin every day.
Your care team can give advice on your individual risks, whether you need regular check-ups, and any early signs to look out for.
Ivy Ashworth-Crees talks about how much better her life is since her double kidney and pancreas transplant.
"Over 30 years ago, I started to have diabetes and had to have insulin injections four times a day. I also had to work hard on my diet to make sure I didn’t eat too much sweet food.
"After about 25 years, I got kidney failure and, in 2003, I had to go on kidney dialysis. The kidney dialysis was very uncomfortable. It was a drain, having to do it four times a day, as well as having the diabetes injections four times a day. I felt like my life was on hold.
"I was on kidney dialysis for two years when they put me on the list to have a kidney transplant. The surgeon suggested that I could probably benefit from a kidney and a pancreas transplant, which meant I wouldn’t be a diabetic any more.
"When I got the phone call to say that I was going to Manchester for the transplant, I was absolutely hysterical. I was a bag of emotions, both thrilled and terrified.
"When I came round after the operation, I was in intensive care. I stayed there for about three or four days, then I was taken to the main ward.
"The most difficult part was getting out of bed and starting to walk. They walked me up and down the ward for weeks until my legs got strong enough. That was very, very difficult. The pain was very bad, but it’s all been worth it.
"The doctor asked me to reduce my weight, so I joined the gym. I enjoy swimming, I think it’s helping me to keep active. The only problem is that I can’t walk too far.
"It’s vital that I take the immunosuppressant drugs. If I don’t, my body could reject the kidney and pancreas. I have to take them for the rest of my life.
"My life’s changed dramatically. I now take it for granted that I can eat what I want, including chocolates! I’m back at work, I don’t have an injection after my meals, I don’t have to rush home for dialysis and my kidneys and pancreas are working well.
"I feel blessed that I’ve been through this operation and it’s worked so well."
When Dr Carole Angel donated a kidney to her brother, Paul Whitaker, she was able to go home just 48 hours after surgery.
Paul, a self-employed builder from Preston, was diagnosed with end-stage kidney failure in October 2001. "I was astonished to find out I had renal failure," he says. "After a series of headaches, I went to the optician because I thought I needed glasses. He tested my blood pressure and it was so high he sent me straight to my doctor."
He began dialysis in the summer of 2002, but his condition rapidly deteriorated and he was soon registered for a transplant.
His older sister Carole was working as a pathologist in Sheffield. She says: "Paul has always been a strong, tall man, but his illness began to take its toll. He lost three stone in weight."
Paul's family were worried about him. "It was worse for Mum, Dad and our brothers, as they all lived closer to him and could see the daily effect," says Carole. "I knew one of us should donate a kidney, and it just happened to be me.
"I don't see Paul very often, but we have always kept in touch by telephone. When I told him I was willing to donate a kidney, he said that he couldn't ask me to go through with it. I told him he wasn't asking; I was offering. We can be quite stubborn in our family.
"The decision to donate wasn't taken lightly. I had to go through a series of hospital tests and received a lot of psychological support. The whole process took many months. I felt a special responsibility to make sure that my health was good enough to help Paul. The worst thing was not knowing whether it would all go ahead."
Around Christmas 2002, the possibility of "keyhole" surgery was mentioned by the doctors. It was a relatively new procedure for the Manchester renal transplant unit, but offered the advantage of being much better for the donor, with a shorter hospital stay and quicker recovery time.
However, not all living kidney donors are able to have this technique performed on them. It wasn't until Carole woke up after the operation in March 2003 that she knew it had been successful.
"I had the operation on a Thursday morning and was home by lunchtime on Saturday, just 48 hours later. It was incredible. When I was 21, I had my appendix out and that was far worse than the kidney donation operation."
Paul recalls waiting to go into surgery a few hours after his sister. "I must admit, I was worried about what she might be going through. But we managed to see each other as I was being wheeled into theatre and she was being wheeled out. She was very groggy and doesn't remember much, but it gave me a great boost to see her.
"When I eventually came out of surgery, I was wheeled past the side ward where Carole was recovering and she saw me, which made her feel better."
Both Carole and Paul have fully recovered. "The whole experience has changed my outlook on life," says Carole. "Paul is always so positive about things. He always looks on the bright side and this has rubbed off on me."
Paul is back at work again, living life to the full. "I'm overwhelmingly grateful to Carole for what she did for me. She gave me back my life, and I can never thank her enough."
Double kidney transplant recipient Riminder Dosanjh spent four years waiting for a transplant with no kidneys in her body at all.
"I was totally dependent on a dialysis machine for four years, just waiting and hoping every day for a new kidney," says Riminder.
"It was a terrible feeling to know that I had no kidney at all in my body and that I was 100% dependent on a machine to keep me alive. I was on the machine three times a week. It was horrible, really tough."
Riminder, a community health project worker, had her first kidney transplant when she was just four years old, after her own kidneys failed. But 14 years later, the transplanted organ also failed and had to be removed.
Riminder's natural kidneys, which were originally left in her body, were also removed to reduce dangerously high blood pressure. She was without any kidneys and totally dependent on a machine for life.
"Dialysis was dreadful after I had grown up through a perfectly normal childhood with a transplanted kidney. I had never prepared myself for my new kidney letting me down. I had been given a gift, but it had been snatched away."
In January 1997, Riminder was placed on the waiting list for a kidney transplant. She began to count the days until an organ would become available. Her family watched with ever-growing concern as complication after complication arose with her life-preserving dialysis treatment.
"I was getting some pretty serious complications with my dialysis. My veins were not strong enough and doctors had run out of space on my arm to link me to the dialysis machine. The treatment wasn't working properly at all and I was becoming desperate for a transplant," she said.
"This made me even more determined to get on with my life, to carry on working and make people accept me for who I am. I didn't want to be known as the one who was ill.
"I was hooked up to the machine one day and a doctor came and asked me whether I wanted a new kidney. I was whisked off to Hammersmith Hospital and woke up with a new kidney and a new life. But it didn't hit me until much later that I had finally got my life back."
That was in December 2000, and Riminder's life has improved dramatically. Now fully fit, she works as a development officer and is active in promoting organ donation.
She says: "I can't express how grateful I am to the donor. I only know that it was a 55-year-old man. I'd like to know more, but that's all the family want me to know, which is OK.
"I would love more Asian people to sign up to be organ donors to save people like me.”