What You Need to Know about a Kidney Transplant

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1 Page 1 of 5 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.) 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. For informational purposes only. Not to replace the advice of your health care provider. Copyright 2010 Fairview Health Services. All rights reserved. SMARTworks REV 01/18.

2 Page 2 of 5 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.

3 Page 3 of 5 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

4 Page 4 of 5 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.

5 Page 5 of 5 Other treatments There may be other ways to treat your condition. Please talk about this with your health care team. Some options are: No treatment Dialysis Medicines Controlling what you eat and drink Treatment for pain and other symptoms (palliative care) You may also qualify for an experimental treatment or research study. Ask your doctor to learn more. 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 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. If you are deaf or hard of hearing, please let us know. We provide many free services including sign language interpreters, oral interpreters, TTYs, telephone amplifiers, note takers and written materials.