Your Complete Guide to Kidney Transplant: Evaluation, Surgery, and Post-Transplant Care
Living with kidney failure can be physically demanding and emotionally exhausting. The constant fatigue, dietary restrictions, and regular dialysis sessions often take a toll on every aspect of life. Thankfully, kidney transplant offers a way forward. By replacing the damaged kidney with a healthy one, it restores the body’s natural balance, reduces dependence on dialysis, and helps patients regain their strength and independence. For many, it means the freedom to live normally again to work, travel, and enjoy life without constant medical limitations.
In this article, we will explore the complete kidney transplant journey, from evaluation and surgery to recovery and long-term care, to help you understand what to expect at every stage.
When is a Kidney Transplant Needed?
A kidney transplant surgery is usually considered when kidney function drops below 10–15% of normal capacity and dialysis becomes necessary to maintain life. The most common causes of kidney failure include:
- Chronic diabetes and hypertension
- Polycystic kidney disease
- Glomerulonephritis (inflammation of the kidney’s filtering units)
- Recurrent kidney infections or urinary tract obstructions
- Autoimmune disorders such as lupus nephritis
Doctors recommend a transplant when medical management and dialysis are no longer sufficient to sustain overall health and wellbeing.
At this point, a nephrologist evaluates if transplantation is the most suitable option. Early referral for assessment helps in identifying potential donors, completing necessary tests, and preparing the patient before health declines further.
Types of Kidney Transplants
Kidney transplants are categorised based on the type of donor:
- Living Donor Transplant: A healthy person, often a family member or friend, donates one of their kidneys. Living donor kidneys usually function immediately and last longer.
- Deceased Donor Transplant: The kidney is obtained from a person declared brain-dead whose family consents to organ donation. These kidneys are carefully matched and allocated through organ-sharing networks.
- Paired Kidney Exchange: In cases where a donor and recipient are incompatible, they may swap donors with another pair for a compatible match.
Evaluation Before a Kidney Transplant
Before undergoing a transplant, both the recipient and potential donor must complete a detailed medical evaluation to ensure safety, compatibility, and long-term success. This process is led by a nephrologist and a multidisciplinary transplant team.
Recipient Evaluation
The patient’s health is assessed through:
- Blood tests to check for infections, immunity levels, and blood type.
- Heart and lung evaluations to confirm surgical fitness.
- Imaging scans of the kidneys and bladder to assess structure and blood flow.
- Cancer and infection screenings to ensure no active disease interferes with the procedure.
- Psychological and nutritional assessments to prepare mentally and physically for the journey ahead.
Donor Evaluation
Kidneys for transplantation can come from either a living or deceased donor.
- Living donors undergo blood type and tissue matching, crossmatch tests, kidney imaging, and full medical and psychological screening to confirm compatibility and safety.
- Deceased donors are evaluated by the organ retrieval team to ensure medical suitability. The recipient is notified immediately once a compatible kidney becomes available, and final matching tests are done before surgery.
Once both donor and recipient are cleared, the surgery is scheduled.
Preparing for the Surgery
Before the operation, patients undergo preoperative preparation to optimise their health. This step involves:
- Routine tests such as blood work, ECG, and chest X-rays.
- Review of ongoing medications; certain drugs may be adjusted or stopped temporarily.
- Dietary and hydration advice to prepare the body for anaesthesia.
- Counselling sessions for patients and families to understand the procedure, recovery process, and post-surgery expectations.
Patients are typically admitted to the hospital a day before surgery. For deceased donor transplants, surgery is performed immediately after organ availability is confirmed.
Kidney Transplant Procedure – A Step-by-Step Overview
Anaesthesia and Preparation
Before the procedure begins, the patient is given general anaesthesia to induce deep sleep and eliminate pain. The surgical area, usually the lower abdomen, is cleaned and sterilised. Intravenous lines and monitoring devices are connected to continuously track vital parameters such as heart rate, blood pressure, and oxygen levels throughout the surgery.
Surgical Incision
The surgeon makes a curved incision in the lower abdomen, usually on one side (commonly the right). This approach allows easy access to the major blood vessels, the iliac artery and vein, which will supply blood to the transplanted kidney.
Unlike what many assume, the patient’s diseased kidneys are generally not removed, unless they are chronically infected, cancerous, or causing high blood pressure that cannot be controlled by medication.
Placement of the Donor Kidney
The donor kidney is carefully positioned in the recipient’s pelvic cavity, just above the groin. Placing it here makes it easier for surgeons to connect the new kidney’s blood vessels and ureter and also ensures better post-operative monitoring and access if needed.
Connecting the Blood Vessels
The most critical step in the surgery is the vascular anastomosis, the joining of blood vessels.
- The renal artery of the donor kidney is connected to the external iliac artery of the recipient.
- The renal vein of the donor kidney is connected to the external iliac vein.
These connections restore the blood supply, allowing oxygen and nutrients to flow into the transplanted kidney.
Attaching the Ureter
Once the kidney has been connected to the blood vessels, the surgeon attaches the ureter (the tube that carries urine from the kidney to the bladder) to the recipient’s urinary bladder. A small stent (temporary tube) may be placed in the ureter to keep it open and prevent blockage while healing occurs. This stent is usually removed after a few weeks through a minor outpatient procedure.
Restoring Blood Flow and Testing Function
After all connections are complete, the surgical team gradually restores blood flow to the transplanted kidney. In most cases, the kidney starts producing urine immediately on the operating table. However, in some cases, especially when the organ is from a deceased donor, it may take a few days to regain full function, during which dialysis may be temporarily required.
Closure of the Incision
Once the surgical team confirms that the transplanted kidney is functioning properly and there are no leaks or bleeding, the incision is closed in layers using absorbable sutures or staples. A small drain may be placed near the surgical site to remove excess fluid or blood, which is usually removed after a few days.
Post-Surgery Monitoring and Recovery
After the operation, the patient is moved to a specialised transplant intensive care unit (ICU) for close observation. The transplant team closely monitors urine output, which serves as the first sign of how well the new kidney is functioning. They also keep a constant check on blood pressure, fluid balance, and any early signs of rejection or infection. During this phase, the patient receives appropriate pain relief, intravenous fluids, and antibiotics to support recovery and prevent complications.
Most patients stay in the hospital for 7–10 days before being discharged. Upon returning home, it’s crucial to follow all medication schedules and attend follow-up appointments. The early weeks are critical for detecting and managing any signs of infection or rejection.
Life After a Kidney Transplant
Life after a transplant often feels like a fresh start. However, maintaining kidney health requires ongoing care and discipline.
Regular Follow-ups
Patients must attend regular check-ups with their nephrologist to monitor kidney function and overall health. Frequent Kidney Function Tests are performed to ensure the new kidney is filtering blood efficiently and that medication levels remain balanced.
Medication Management
Immunosuppressants are essential for preventing rejection but can make patients more vulnerable to infections. Doctors adjust dosages carefully, and it’s vital never to skip doses or stop medication without medical advice.
Lifestyle and Diet
A healthy lifestyle supports long-term transplant success.
- Eat a balanced, low-sodium diet with adequate protein.
- Stay hydrated, but avoid overconsumption of fluids.
- Maintain a healthy weight and exercise regularly under guidance.
- Avoid smoking and limit alcohol intake.
Emotional and Physical Wellbeing
Recovery isn’t just physical, patients often need emotional adjustment as well. Support groups, counselling, and family involvement can make this transition smoother. With time, most recipients return to work, travel, and daily routines with improved energy and independence.
Common Complications and Their Management
Although kidney transplants are highly successful, complications can occasionally occur. The most common include:
- Rejection: The immune system may recognise the new kidney as foreign and attack it. This is managed with immunosuppressive medication and close monitoring.
- Infections: Because of lowered immunity, patients are more prone to infections. Preventive hygiene, vaccines, and early treatment help reduce risks.
- Medication side effects: Long-term drug use may cause weight gain, diabetes, or high blood pressure, all of which can be managed through lifestyle changes and medication adjustments.
With timely follow-up and proper care, most complications can be detected early and successfully controlled.
Cost and Success Rate of Kidney Transplant in India
India has become one of the most sought-after destinations for kidney transplants, offering advanced medical facilities, skilled surgeons, and high success rates at comparatively lower costs.
The cost of a kidney transplant in India varies depending on factors such as hospital type, donor source, and post-operative care but is generally far lower than in many Western countries.
Modern techniques, experienced transplant teams, and improved access to immunosuppressive medication have led to success rates exceeding 90% in most centres. Many patients go on to live normal, healthy lives for years after surgery, especially when they follow medical advice and maintain regular check-ups.
Conclusion
A kidney transplant offers a new lease on life for patients with end-stage kidney disease. It restores kidney function, eliminates the need for dialysis, and allows individuals to regain strength and independence.
The journey begins with timely evaluation through Kidney Function Tests, guided by an experienced nephrologist, and continues through careful post-transplant management. With the right medical support, adherence to medication, and healthy lifestyle habits, most patients enjoy long-term success and a vastly improved quality of life after a kidney transplant.
