What is a Kidney Transplant?

What is a kidney transplant?

A kidney transplant is a surgical procedure in which a healthy kidney from a living or deceased donor is implanted into a person with advanced chronic kidney disease (Stage 4 CKD) or end-stage renal failure (ESRF; Stage 5 CKD, kidney failure).

Rather than removing the patient’s own kidneys, the transplanted kidney is usually placed in the lower abdomen and connected to the blood vessels and bladder.

For many patients, kidney transplantation offers better survival, improved quality of life, fewer dietary restrictions, and greater independence compared with long-term dialysis.

Kidney Transplant Work-Up (Transplant Evaluation)

A transplant work-up is a detailed medical and psychosocial assessment to ensure transplant safety and success.

Medical Evaluation 

• Blood tests (blood group, HLA typing, antibodies)
• Crossmatch testing with potential donors
• Cardiac assessment (ECG, echocardiogram; and in some, stress testing or coronary angiogram)
• Cancer screening (age-appropriate)
• Infection screening (Hepatitis B/C, HIV, TB)
• Imaging of urinary tract

Non-Medical Assessment

• Medication adherence history
• Psychological readiness
• Social support and caregiver availability

The work-up ensures that the benefits of transplantation outweigh the risks.

Who Is Eligible for a Kidney Transplant?

Aboout 30% of patients with ESRF are potential candidates, but eligibility depends on overall health.

Common Eligibility Criteria

• Irreversible kidney failure (eGFR typically <15 ml/min)
• Acceptable heart and lung function
• No active infection or untreated cancer
• Ability to take lifelong immunosuppressive medication
• Demonstrated adherence to medical care

Contraindications (May Be Absolute or Relative)

• Active malignancy. If a patient has had a cancer, it is normally expected to not have recurred within 5 years of the original diagnosis
• Ongoing substance (e.g. recreational drug) misuse
• Severe, uncontrolled cardiovascular or respiratory disease
• Untreated psychiatric illness affecting adherence

Note. Age alone is not a contraindication though few transplants are done on patients over 70 years. Physiological fitness matters more than chronological age.

How Is a Kidney Transplant Performed?

Surgical Procedure

• The transplant kidney is placed in the iliac fossa (lower abdomen)
• Blood vessels of the donor kidney are connected to the iliac artery and vein
• The ureter is attached to the bladder to allow urine drainage
• Native kidneys are typically left in place unless there is infection, cancer, or severe symptoms
• The operation takes 2-3 hours
• Most patients need 7-14 days in hospital after the transplant

Types of Kidney Transplants

• Living donor transplant (related (LRTx) or unrelated (LURTx))
• Deceased donor transplant (DDTx)
• Pre-emptive transplant (performed before dialysis starts)

Living donor transplants generally last longer and can be scheduled electively, reducing time on dialysis.

Commonly Used Immunosuppressive Medications

To prevent rejection, patients must take lifelong immunosuppression.

Typical Maintenance Immunosuppressive Regimen

1. Calcineurin Inhibitors

• Tacrolimus (most common)
• Ciclosporin

Drug levels are closely monitored to balance rejection risk and toxicity.

2. Antimetabolites

• Mycophenolate mofetil (MMF)
• Mycophenolic acid
• Azathioprine (less common)

3. Corticosteroids

• Prednisolone (may be reduced or withdrawn in selected patients)

Induction Therapy (Early Post-Transplant)

• Basiliximab
• Antithymocyte globulin (ATG)

Follow-Up After Kidney Transplant

Early Post-Transplant

• Frequent clinic visits (often weekly)
• Blood tests for kidney function, and drug levels
• Blood pressure and glucose monitoring

Long-Term Follow-Up

• Lifelong transplant clinic care
• Regular screening for infection, cardiovascular disease, and cancer
• Monitoring for chronic rejection and medication side effects

Adherence to follow-up is as critical as adherence to medication.

Complications of Kidney Transplantation

Short-Term Complications

• Delayed graft (kidney transplant) function
• Acute rejection
• Surgical complications (bleeding, urine leak)
• Infection

Long-Term Complications

• Chronic allograft dysfunction (slow deterioration of transplant function)
• Cardiovascular disease
• Post-transplant diabetes
• Increased cancer risk (especially skin cancer (common); and 2-5% risk of lymphoma, especially in first 2 years)
• Medication-related toxicity (kidney, bone, metabolic effects)

Early detection and specialist follow-up significantly reduce long-term risk.

How Long Does a Kidney Transplant Last?

Kidney transplant survival varies depending on donor type, immune compatibility, and post-transplant care.

Average Graft Survival

• Living donor kidney: 15–20 years (or longer)
• Deceased donor kidney: 10–15 years (or longer)

Some transplants function for several decades, especially with excellent medication adherence and follow-up.

Note. There some younger patients may require 2 or more transplants in their lives.

Life After Kidney Transplant

Most patients experience:

• Improved energy and cognition
• Fewer dietary and fluid restrictions
• Return to work and travel
• Improved sexual health and fertility (with planning)

However, transplantation is not a cure—it is a long-term treatment requiring active patient engagement.

Key Takeaway

A kidney transplant is the preferred treatment for eligible patients with end-stage kidney failure, offering longer survival and better quality of life than dialysis.

Success depends on careful selection, thorough work-up, expert surgical care, lifelong immunosuppression, and consistent follow-up.