A patient’s guide to pre-transplantation
Genentech Transplantation, your partner in patient education
You Are Considering a Kidney Transplant…
What Happens Next?
Because your kidneys aren’t working properly, you are faced with
an important decision: whether to start dialysis, possibly for life,
or to have a kidney transplant. Many people prefer a kidney
transplant because it gives them a lifestyle free from dialysis and
allows them to enjoy a less restricted diet.
In order to do what’s right for you, learn as much as you can before
you make a decision. It can be helpful to talk to other patients who’ve
already had a kidney transplant. Also, don’t hesitate to talk to your
transplant team about any issues or concerns you may have.
If you are thinking about a kidney transplant, you should ask
yourself the following questions:
• Am I willing to go through all the tests and doctor’s
visits to get ready for the transplant?
• Am I willing to wait months or maybe years to
get a kidney?
• Am I willing to follow all my doctor’s instructions
after the transplant?
• Am I willing to possibly take medications for the
rest of my life?
If you have answered “Yes” to these questions, you’re ready
for the next step.
Individuals shown are not real transplant patients or organ donors.
Important Facts About the
Kidneys and Their Functions
What do your kidneys do? • Filtering and removing waste by
Your kidneys are 2 bean-shaped
organs located behind your stomach • Helping to regulate blood pressure
in the middle of your back, on either
• Cleaning and controlling the
side of your spine. Each kidney
amount of blood in your body
is about the size of your fist and,
although they may be small, kidneys • Keeping the body’s balance of
perform some of the most important water, salt and acid constant
jobs in your body.
• Making hormones that help bone
marrow produce red blood cells
What happens when the When the kidneys are not working
kidneys are not working correctly, the body’s waste and
the way they should? excess fluids build up, causing harm
to the body. Some signs of kidney
If something happens to abnormally disease are:
change the way the kidneys function,
it is usually because of a condition • Fluid retention—puffiness in the
that has been attacking the kidneys face, swelling of hands and feet
for some time. This leads to chronic
• A change in urination (frequent,
kidney disease which generally affects
painful or difficult)
both kidneys. The kind of condition
you have might be something you • Shortness of breath
were born with; it could run in your
• Mental confusion
family or it could be a problem that
developed over time (such as a • Abnormal blood or urine
problem due to long-term use of over- test results
the-counter pain relievers). There may
be no symptoms of kidney disease
until you have had it for a while.
When is a kidney • Cancer
transplant a consideration?
Some of the conditions that can injure
• Injury or trauma
the kidney and lead to chronic kidney
disease are: If kidney disease has not been
diagnosed or treated early enough,
or if the patient has not responded to
• High blood pressure treatment, the disease may progress
to kidney failure. At this point, the
• Glomerulonephritis (inflammation
kidneys have usually stopped working,
of the kidneys’ filtering units)
requiring dialysis (for life) or kidney
• Polycystic kidneys transplantation. A transplant has
(cysts that enlarge over time) high success rates and offers the
opportunity to live dialysis free.
• Kidney stones
Types of kidney Whichever option is right for you,
transplant surgery it is important to know that there
may be some concerns if you
In order for transplant surgery to have a history of alcohol or illicit
take place, you will need a donated substance abuse. If this pertains
kidney, either from someone who has to you, you can still be a candidate
died or from a living donor. Currently, for transplantation. However, you
the national 1-year survival rate for may need to show that you have
kidney transplant patients is as high participated in a rehabilitation
as 95% for patients receiving a kidney program for 6 months and are
from a deceased donor, and 98% for successfully avoiding the use of
those receiving an organ from a living either alcohol or illicit substances,
donor. or both. You may be required
Research has found that, on to take screening tests to prove
average, a patient on dialysis has your abstinence.
more medical complications and
does not live as long as a patient
who has had a successful
So, as you can see, kidney
transplantation can be a successful
treatment for kidney disease. There
are 2 possible kidney transplant
procedures that you may want to
discuss with your transplant team
to determine which option is right
• Live donor kidney transplant
• Deceased donor kidney transplant
Live donor kidney transplant who are at least 18 years old and
cousins. There is also a possibility
A living donation is provided when a
that an altruistic (“Good Samaritan”)
person (while alive) gives one of his
nonrelated donor may be found, but
or her own kidneys to someone who
this is not yet widely accepted.
needs one. Those who are related
to you make the most successful If a live donor kidney transplant is a
donors because their blood and possibility for you, your transplant
tissues are usually similar to yours. center will have a long list of
Living donors can be parents, requirements for the potential donor,
siblings, aunts and uncles, children which may include:
• Over 18 years of age and in good Deceased donor kidney
physical condition (some centers transplant
require the donor to be at least
21 years old) Deceased donors are people who
have died and donated their organs
• Passes all physical and for transplantation. Unfortunately,
psychological testing these organs are in short supply, so if
this is the procedure for you, you will
• Compatible blood type (listed
probably be put on a waiting list until a
in the table below) and normal
compatible kidney becomes available.
kidney and liver function
It is difficult to estimate how long the
• Willing and prepared to handle the wait might be.
physical, emotional and financial
challenges of major surgery, with
full awareness of the risks involved
Not everyone who needs a kidney
transplant is a candidate for a living
donor transplant. In this case, a
deceased donor transplant may
be an option.
Compatible Blood Types
Recipient’s Blood Type Donor’s Blood Type
A A or O
B B or O
AB A, B, AB or O
“The list”—waiting for a deceased Antibodies—These help your body
donor kidney. There is a designation fight off foreign cells that might have
system in place to ensure that formed in your body because of a
those patients in need of a kidney prior transplant, blood transfusion
transplant are given priority based on or pregnancy.
a variety of factors. This is managed
Crossmatch—A test is done to see if
by an organization called the United
there is anything in your blood that will
Network for Organ Sharing (UNOS).
react against the cells of the donor.
UNOS coordinates efforts among all
the different transplant centers in the Time—The longer you’ve been on
country to allocate donated organs the waiting list, the better your
for transplantation. chance of receiving the next suitable
kidney. Every time a kidney becomes
Your position on the waiting list
available in an area, a list of patients
will depend on:
potentially compatible with that
Blood type (O, A, B or AB)— kidney is generated. If you are not
Blood type must be compatible a perfect match with the donor,
(not necessarily a match) if you kidneys are allocated based on the
have a living donor, but to receive closest match and your time on the
a deceased donor organ, the blood waiting list.
type must be the same.
Your transplant team and the UNOS
Tissue type—There are 6 important Web site, www.unos.org, will have
antigens that are determined from the most current information.
your blood sample. If you match the
donor on all 6, this is a perfect match
and moves you to the top of the
waiting list, even if you have been
waiting a short time.
You are only on “the list” when As you never know when a donor will
your transplant nurse coordinator be available for you, it is important
or doctor confirms that you are that you stay in constant contact
on the list. Some patients mistakenly with your coordinator. If you move or
think they are automatically listed change any of your phone numbers,
once they have been referred to a please be sure to give this information
transplant center, or after they have to the transplant center, so you can
completed testing. If you are not be reached immediately when it is
absolutely sure that you are on the your turn to receive a donor kidney.
list, talk to your transplant coordinator.
What are the possible • Bleeding
complications of surgery? • Delayed or no function of the
As with any surgical procedure, there new kidney
is always a possibility of complications. • Psychological and social changes
After a kidney transplant, there may be • Fever
a risk of:
• Problems urinating
• Infection • Abdominal bloating
• Rejection of the new kidney • Death
• Clotting of a blood vessel
Pre-transplant screenings • Kidney and liver function
There are a number of tests that • The presence of viruses and/
will be performed and repeated for or antibodies to viruses.
anyone who is being considered Exposure to some common
for an organ transplant. These viruses will not rule out kidney
evaluations reveal your overall health transplantation but will be taken
and help your transplant team into account when monitoring
determine if transplantation is right your condition after surgery.
for you. Some or all of the following In some cases, vaccination
tests—and possibly more—may be prior to transplantation may
required by your transplant team. be required
Blood tests are conducted to rule • Panel Reactive Antibody (PRA) test
out certain infectious diseases and is a way of measuring how active
provide information regarding: your immune system is. This level is
usually higher when more antibodies
• Various blood cell counts, such as are being made. It is easier to get a
white cells, red cells and platelets
kidney when the immune system is
• Blood typing (O, A, B or AB), calm or PRA measures 0%
which will help determine your
compatibility with a potential donor
• Blood chemistries, including those
that measure glucose and electrolytes
Other Common Pre-transplant Tests (Kidney)
Test type What it measures
Blood urea nitrogen (BUN) Kidney function—the waste product of protein
breakdown that is removed from the blood by
Bicarbonate (HCO3 ) Acid/base balance of blood as controlled by
Calcium Calcium—needed for blood clotting, building bones
and also muscle, heart and nerve function
Creatinine (Cr) A protein waste produced by muscles and released
into the bloodstream for removal by the kidneys.
Measuring creatinine in the blood helps show
how the kidneys are working
Phosphorous (PO4) Phosphorous levels in the blood—important
in creating energy
Potassium (K) Potassium levels in the blood; reflects potassium in
the tissues that is required to change carbohydrates
into energy, build protein and help the heart,
muscles and nerves function
Proteinuria Protein is not normally present in the urine. If it is
present, the quantity of protein may be measured
Sodium (Na) The balance between electrolytes and water in the
body. Also indicates nerve and muscle disorders,
as well as kidney and adrenal gland problems
Urinalysis White blood cells, red blood cells, bacteria and
protein levels in the urine
An increase may mean A decrease may mean
• The kidneys are not functioning properly • Liver disease
• Diet is too high in protein • Too much water in your body
• Some antirejection medications may be
• A lung disorder • A sign of diabetes
• There has been prolonged vomiting • Kidney failure
• Excessive use of antacids
• Too much calcium intake due to excessive • Inflammation of pancreas
use of antacids • Kidney failure
• Bone disorders • Too little vitamin D
• Too much vitamin D • Too much water in the body
• Problem with the thyroid or parathyroid glands
• Dehydration Does not apply
• Kidney disease
• Some antirejection medications may be
• An obstruction within the urinary system
• Kidney failure • Bone disorders
• Too much phosphorous in the diet • Too little vitamin D
• A complication of diabetes
• Excessive use of antacids
• The kidneys are not functioning properly • Use of diuretics (water pills) is causing
• Some antirejection medications may be potassium to be excreted (released)
the cause by the kidneys
• Heart problems
• Muscle cramps
• A kidney disorder Does not apply
• A complication of diabetes
• Excessive sodium in the diet • Chronic kidney disease
• Not enough water in body • Inadequate sodium intake
• Kidney function problems
• Kidney disease Does not apply
• Urinary tract infection
• Poorly controlled diabetes
Chest x-ray will help determine the heart or vascular disease, or have
health of your lungs. significant risk factors for hidden,
silent (occult) heart disease.
Imaging scans can show the size
and shape of the kidneys and major Urinalysis can detect and measure
blood vessels. Some imaging scans cells and substances that may
that may be performed include: indicate disease or infection.
• Abdominal ultrasound Pulmonary function tests—
breathing forcefully into a tube—
• Computerized axial tomography
measure how well your lungs are
working and the ability of your
• Magnetic resonance imaging blood to carry oxygen.
(MRI), when more detailed
Interviews with a transplant
information is needed
social worker, a psychiatrist and a
Electrocardiogram (EKG) shows transplant nurse coordinator may be
heart function and reveals any past required to confirm your eligibility
damage. Additional heart tests may for transplant.
be required if you have a history of
Keep a record of all the tests you may need
You and your transplant team may use the following table to keep track of
the pre-transplant tests you may be required to have. Your nurse can check
off those that are necessary for you in the “required” column, or add any
additional tests required by your center. Carry this booklet with you, so you
always have a record of what needs to happen, when it needs to happen
and when it is done.
Pre-transplant tests and evaluations
Test Required Date Scheduled Completed
Alpha fetoprotein (AFP)
Arterial blood gas
Complete biochemical and liver profile
Complete blood count (CBC)
Drug and alcohol screening
Test Required Date Scheduled Completed
Upper endoscopy (EGD)
Prostate specific antigen (PSA)
Cardiac (thallium) stress test
Nuclear bone scan
Pulmonary function test
Ultrasound of abdomen
What does all this Is everyone a candidate
testing mean? for kidney transplantation?
Most of the tests and interviews Not everyone is a candidate for
you will undergo are performed kidney transplantation. The following
to help your transplant team decide may prevent a person from receiving
how best to increase your chances a transplant*:
of achieving the most successful
• Severe liver, heart or lung disease
results from your kidney transplant.
These tests and discussions will • Advanced cancer
• Active use of alcohol or
• Your disease can be treated illicit substances
effectively with a kidney transplant
• Advanced HIV disease (AIDS)
• There are any problems, such
as blocked or closed blood
• Proven history of not following
medical directions (noncompliance)
vessels, that could interfere
with successful surgery The most important consideration is
that you are healthy enough to have
• Your heart, lungs and liver are able
to withstand transplant surgery
• There are emotional, psychological
or family issues that must
* Each transplant center has its own criteria for potential transplant candidates. Be sure to check with your center
about the particular factors that might exclude you from being considered for an organ transplant.
Who are the members of The transplant surgeon evaluates
your transplant team and whether you qualify for a kidney
what do they do? transplant and will perform the actual
surgery. After surgery, he or she looks
It is important for you to know the for possible surgical complications.
medical professionals who will be This is the physician who can answer
taking care of you and exactly what many of the questions you may have
they do. Each of these experts about the surgery and its risks.
is a specialist in his or her field
with a very distinct job. Following The transplant nephrologist is
is a description of the typical a kidney specialist who usually
team members involved in kidney monitors all nonsurgical aspects of
transplantation, but your team may your care, such as kidney function,
be slightly different. You can use this rejection episodes and post-
information as a guide to understand transplant medications. You will see
your available resources. this doctor often—feel free to ask as
many questions as you want.
The consultant physicians may laboratory results, educating you
include cardiologists, infectious post-operatively, providing discharge
disease specialists, hematologists/ instructions and serving as the
oncologists, anesthesiologists, keeper of all your medical information.
psychiatrists, psychologists, Think of him or her as the center of
pulmonologists and hepatologists. the wheel of professionals around
With transplant care, many medical you—someone who will keep track
specialties are involved to make sure of how you are doing throughout the
you have the complete care you need. entire transplant process.
The transplant nurse coordinator The physical therapist will create
is a licensed, registered nurse who an exercise plan to help you prevent
is responsible for many duties, muscle deterioration, control your
some of which include organizing weight and maintain a normal level
your patient evaluations, monitoring of activity after your surgery.
The dietitian/nutritionist is a The pharmacist can help
licensed professional trained in the oversee and coordinate the many
science of diet and nutrition. This medications you will be taking after
team member will design healthy the transplant, as well as explain any
meal plans for you both before and side effects you may experience.
after your transplant. He or she
Other team members may include
will also develop special diets for
physician assistants, operating room
patients with medical issues. Be
and intensive care nurses, nurse
sure to ask about any food or
practitioners, medical residents,
procurement coordinators, case
The financial planner/coordinator managers and transplant assistants.
is specially trained to help patients
You play an important role in the
and their families deal with the
transplant process and are one of
financial burdens of an organ
the most essential members of the
transplant. This professional will
team. Help yourself by being an
explain what your insurance will and
active participant in your own care.
will not cover; help you determine
Share your feelings, ask questions,
if you qualify for coverage from
talk about issues that are important to
Medicare, Medicaid or private
you—open communication is how the
insurance and direct you to
rest of your team will know how you
available financial resources.
are doing and what you are thinking.
The social worker can help you
and your family cope with the
nonmedical aspects of the
transplant. By working closely with
you, the social worker can identify
emotional or family issues that need
attention, and link you to community
services, such as support groups,
you might find useful.
Stay healthy prior to • Do not drink alcohol or use illicit
transplantation substances. If you smoke and
have had difficulty quitting, ask
Physically your team to direct you to the
help you need
• Stay as active as you can, and take
care to keep your muscles toned • Lose weight, if necessary, to
within your physical limitations reduce the risk of complications
during and after your transplant
• Eat healthy, well-balanced meals. and, most importantly, to protect
If you have any food restrictions, your overall health
you can get information about an
appropriate eating plan from your • Get treatment for other
transplant center, or meet with healthcare problems, including
your dietitian to customize a plan high cholesterol, high blood
that accommodates your tastes, pressure and diabetes
health and habits
Emotionally • Join a support group through your
transplant center. This forum for
• It is very important to be
learning and sharing can be very
as mentally and emotionally
valuable to you and your family
healthy as possible. If you are
having trouble coping, there • Keep connected—even though
are relaxation techniques you you may often be very tired—
can try or counseling might make every effort to stay in
be a consideration. This can touch with the people you care
help you have a more positive about; your support group is
transplantation experience very important at every stage
in the transplant process
• Depression is not uncommon
among people awaiting • Try to let people help you when
transplantation. Your transplant they offer. Learn to say “yes,” even
team wants to know how you’re if accepting help is hard to do.
handling the stress of your situation. Those who offer usually really want
They can advise you about all of to help but don’t know what would
your options from support groups be most useful to you. Allow them
to antidepressant medications to pick up groceries, run errands,
cook a meal or two—whatever will
save you time and energy
Be prepared Surgery and recovery
Be prepared financially. Be proactive
in finding out what your options
are through private insurance and
Medicare/Medicaid, and what Kidney transplantation typically takes
supplemental coverage you may 3 to 4 hours. It is hard to definitely
need. Rest assured that there is predict how long the operation
someone at your transplant center will take, but your surgeon will
who is eager to help you make the update your family while surgery
financial plans that will minimize your is in progress. Removing your
stress and prepare for your future. nonfunctioning kidneys is usually
Ask your team. not necessary unless there is a
special reason to do so.
Arrange for someone to:
Prior to transplant, your surgeon
• Transport you to the center when will discuss the actual procedure
the call comes and possible risks with you in detail.
Many patients want to know how
• Prepare food and care for you
long the recovery time following
transplantation will be. Your
• Accompany you to the center condition prior to the surgery often
for your follow-up visits and help affects your recovery time.
keep track of your medications
When you first wake up after the
• Clean, do laundry and straighten surgery, you will probably feel
up for you when you’re not able groggy and a little sore. However,
to “do for yourself” most patients are surprised at
how well they feel right after the
transplant. Typically, you will be in
the intensive care unit for 1 to 2 days After everything you will go through
and in the transplant unit for about 7 together, your transplant team will
days. A longer stay may be needed, seem like family. They will closely
depending on your individual case. monitor your progress post-transplant.
You’ll receive clear instructions and
You might anticipate a 2- to 6-month
encouragement about taking your
disability period, or even longer if
medications, monitoring your health
your physical condition dictates.
and making the most of your second
Physical therapy may be needed to
chance at life.
help build up your strength. After a
transplant, most patients feel better
and stronger as each day passes,
with their new kidney doing the job
it’s supposed to do.
Keeping your kidney schedule may be changed, and
healthy sometimes other medications will be
added to stop the rejection. Once
To continue to enjoy the healthy the rejection is under control, you
functioning of your transplanted will probably be able to go back to
kidney, there are 3 things to your regular medication schedule.
2. Have your follow-up
1. Take your medications laboratory work done
To your body, the donor kidney as scheduled
may seem like something from It is also important that you have
the outside that doesn’t belong. the follow-up laboratory tests
Your body’s protective immune done as frequently as advised by
system will recognize your new your transplant team. That way the
kidney as foreign. This is why you team can monitor the health of your
will need to take a number of new kidney, and make certain the
medications for the rest of your medications are working.
life. They are called “antirejection”
or “immunosuppressive” drugs. 3. Communicate with
Before you leave the hospital, your your transplant team
transplant team will make certain
Always tell them of anything that has
that you fully understand what your
happened to change your health. If
medications are for, and how and
you have any questions, no matter
when to take them.
how small they might seem, call your
If your body begins to reject your transplant team and ask them. They
new kidney, you may not feel ill. But are there to help you. They’ve been
your kidney function will weaken, with you from the beginning of your
and this can be detected by journey and will be with you as you
laboratory tests. If organ rejection start your new life.
is taking place, your medication
The following is a list of terms you Coagulation (coe-ag-u-LAY-shon).
may hear your healthcare team use The process of blood clotting;
during the transplant process. usually the body’s way of controlling
Acute rejection. The body’s way
of trying to destroy a transplanted Compliance (com-PLY-ants). The
organ because it senses the organ is process of a person following the
a foreign substance. If it is going to instructions of his or her transplant
happen, acute rejection usually occurs team or center, usually regarding
within the first year after the transplant. the taking of medication.
Antibody (AN-tee-bod-ee). A Crossmatch. A test for recipient
protein that is produced by the antibodies versus donor antigens.
body’s immune system when it
detects a foreign substance,
a-lo-vie-rus) (CMV). A common
such as a transplanted organ.
viral infection that may affect organ
Antigen (AN-tah-gin). A substance, recipients as they usually have a
such as a transplanted organ, that weakened immune system.
can trigger an immune response;
Deceased donor. Someone who
an immune response may be the
has died and donated his or her
production of antibodies.
organs for transplantation.
Candidate. A person who is waiting
Deceased donor organ. An organ
for an organ transplant.
from a person who has been
Chronic rejection. The slow failure declared brain dead.
of a transplanted organ over time.
Diuresis (die-yur-EE-sis). An Immune system. The body’s natural
increased production of urine. defense mechanism to fight what
it detects as foreign bodies. In
Donor. Someone from whom an
transplantation, the body may sense
organ or tissue is taken and used
the new organ as a foreign body
for transplantation into someone
and the recipient’s immune system
will naturally want to defend itself by
End stage renal disease (ESRD). trying to reject the organ.
Failure of the kidneys to function,
Immunosuppressant. A drug that
requiring the patient to need dialysis
helps the body recognize and accept
or a kidney transplant to survive.
a transplanted organ by suppressing
Graft. A transplanted organ or tissue. the immune system.
Noncompliance (non-com- Tissue typing. A blood test to identify
PLY-ants). Failure of the patient to how closely the tissues of the donor
follow instructions provided by his match those of the recipient.
or her transplant team or center.
United Network for Organ Sharing
Recipient. The person receiving a (UNOS). A national organization
transplanted organ. that makes sure all patients have a
fair chance to receive the organ they
Side effect. An unplanned (but not
need. UNOS matches donors with
necessarily unanticipated) reaction
recipients and manages the list of
to a drug.
those people waiting for a transplant.
The following is a partial list of where you can turn for support, information
American Kidney Fund National Kidney Foundation
American Transplant Transplant Living
Association (ATA) 1-888-894-6361
Children’s Organ Transplant International Organization
Association (COTA) (TRIO)
Life Options TransWeb
National Foundation for United Network for
Transplants (NFT) Organ Sharing (UNOS)