Kidney transplantation

For those who are eligible, kidney transplantation is the best option for treating kidney failure.

It involves a surgical procedure in which a donor kidney is implanted into the recipient’s abdomen. The kidney can come from a person who has died suddenly (deceased donor) or a living person (living donor).

• 1 in 10 patients on chronic dialysis will receive a transplant
• 1 in 100 patients will receive a transplant without requiring dialysis (pre-emptive)

• If a living donor is available, transplant prior to starting dialysis may be possible
  • Average wait time for Sunnybrook patients is 1-2 years
  • Available to a select group of patients. You and your donor need to be carefully evaluated and this could take 6 – 12 months
• If a living donor is not available, then assessment for transplant can only begin after starting dialysis
  • Average wait time for Sunnybrook patients is 3-7 years

• Some conditions will prevent you from receiving a kidney transplant such as but not limited to:
  • Uncorrectable cardiac or peripheral vascular disease
  • Certain cancers
  • Uncorrectable psychiatric condition or cognitive impairment
  • Severe uncorrectable impaired physical condition
  • Short life expectancy

• No more dialysis required
• No need to follow dialysis schedule
• Less restrictions on diet and fluid
• Improved quality of life – feel healthier
• Fewer hospitalizations
• Lower risk of heart attack and stroke
• Overall, individuals with a kidney transplant live longer than those on dialysis

Potential complications include:

• Complications related to medications
• Acute rejection
• Chronic rejection

"A transplant is a type of surgery where an organ or tissue is removed from one person (donor) and given to another (recipient) to replace the recipient’s damaged organ or tissue." -Trillium Gift of Life Network

• Sunnybrook is not a Transplant Centre
  • Referral is made to Toronto General Hospital or St. Michael’s Hospital
• Most assessment tests are done at Sunnybrook and results are sent to transplant centre
• Appointments for medical and surgical review and education will be scheduled by transplant centre

• No more dialysis required
• No need to follow dialysis schedule
• Less restrictions on diet and fluid
• Improved quality of life – feel healthier
• Fewer hospitalizations
• Lower risk of heart attack and stroke
• Overall, individuals with a kidney transplant live longer than those on dialysis

BUT:

• Transplant is not a cure
• Anti-rejection medications are needed as long as transplant is working
• Medications have side-effects
• Require regular blood and other tests, clinic visits to watch kidney function are needed
• Does not cure high blood pressure, high cholesterol, diabetes, heart disease or other pre-existing illnesses
• Only certain individuals are eligible – medical reasons why not
  • If eligible 1 in 10 patients receive
• No age limit

Transplantation is possible only if individual is able to:

• Safely undergo transplant surgery
• Remain on lifelong anti-rejection medications

Assessment includes

• Blood tests
• Cardiac (heart) tests
• Testing for infectious diseases
• Chest x-ray, ultrasounds
• Screening for cancer
• Meetings with: nephrologist, transplant surgeon, anesthetist, transplant coordinator, social worker
• Other tests and appointments as necessary

Blood group and antibodies

• Part of the transplant assessment includes checking for blood group and certain antibodies
• These are important factors to determine if a kidney is suitable

Blood group compatibility

Antibodies

• Everyone makes antibodies to fight off infections
• Some antibodies may make it difficult to find a suitable kidney
• Tests are done to measure the presence of these antibodies
• Pregnancy, blood transfusions and previous transplants increase the likelihood of developing these antibodies

Deceased donor

• Is only available after dialysis treatments have begun
  • Average wait time stats for Sunnybrook patients is 3-4 years

Living donor

• Is available before or after dialysis treatments have begun
  • Average wait time stats for Sunnybrook patients is 1-2 years

Combined kidney & pancreas

• Is available for some individuals with diabetes

Deceased donor transplantation

• Wait time varies from 1 – 10 years
  • Average wait time stats for Sunnybrook patients is 3-4 years
• Wait time starts from first day of dialysis
• Wait time is influenced by blood type and ability to find a suitable match

Living donor transplantation

Donor must:

• Be in excellent health
• Have normal kidney function
• Have normal blood pressure or easily-controlled high blood pressure
• Not have diabetes

• Donor is assessed by a nephrologist different from recipient
• Risk for approved donors is low
• If there are matching and blood type concerns, transplantation may still be possible
• Living donor transplant is better than deceased donor
  • Average wait time stats for Sunnybrook patients is 1-2 years

Left: mini incision, right: laparoscopic

Paired exchange transplantation

• Find pairs where living donors cannot donate to intended recipients due to antibodies or blood group
• Match up pairs so donor from one pair is compatible with recipient from other pair
• Two pairs exchange kidneys
• Each recipient receives a living donor kidney
• Operations take place at the same time
• Can also have exchanges which involve 2 or more pairs
• Difficult to find matching pairs within one hospital

Surgery

• Generally, native kidneys remain in place
• Incision is about 6” (15 cm) long in lower abdomen
• In hospital for 7 – 10 days
  • Usually longer with a deceased donor kidney
• Dialysis may be required in the short term, before kidney starts working well
  • More common with deceased donor kidney
• First 48 hours spent in “step-down” unit, then move to a regular room
• Before going home the following will be confirmed:
  • Kidney working well and pain is controlled
  • Eating and drinking normally
  • Medication and self-management teaching completed
  • Follow-up is scheduled
• Follow-up:
  • Frequent lab tests at transplant centre initially
  • First clinic visit 1 – 2 weeks after discharge
  • By one year post-transplant
    • Labs once/month or less
    • Clinic every 3 – 4 months or less

• Ongoing communication as needed with transplant kidney team at Sunnybrook during workup
• Group and one-on-one education sessions with social worker and/or coordinator of the transplant kidney team at the transplant centre/hospital
• Regular clinic visits with your transplant kidney team at the transplant centre/hospital after your transplant
• Peer support is available from patients that were donors and those that were recipients

• Overall, people with a kidney transplant live longer than people on dialysis
• Living donor transplant is better than deceased donor
• Transplant team provides further education and support in decision making

Helpful resources

• Trillium Gift of Life 
• Kidney Foundation of Canada