If your kidneys are not working well enough to keep you alive, you may be considered for a kidney transplant. There are two types of kidney transplants: from a living donor or from a non-living donor.

Living-donor kidney transplant

We are born with two kidneys and can donate one kidney and still live a normal life. However, the donor will need to consider the risks of surgery and the recovery time of about four weeks. Living kidney transplants are usually from an immediate family member (i.e., sibling, parent). Living kidney donation may also come from a spouse, friend or stranger.

Living kidney donation must be voluntary without pressure from anyone. Before a donor is accepted, several tests (e.g., physical exam, kidney ultrasound, CT scans, blood and urine tests, psychological tests) must be done to make sure the kidney is compatible and that the donor understands the risks.

Non-living donor kidney transplant

The alternative source of a kidney for transplantation is a cadaver or non-living donor transplant. This type of transplant is from someone who has died, usually from a fatal injury or disease leading to brain death, but can be maintained with a heartbeat and circulation long enough for the kidneys to be removed and used for transplantation.

The supply of donor kidneys is the limiting factor in non-living donor kidney transplants. Enormous efforts have been made to increase kidney and other organ donations, but even where aggressive organ donation programs exist, supply falls well short of demand.

As with living-donor kidney transplants, non-living donor transplants require that there be blood group compatibility between donor and recipient. If the blood group is compatible, then another blood test called tissue typing will be done to ensure that the donor and recipient are genetically similar enough to increase the success of a transplant. For non-living donor transplants, available kidneys are allocated to people on the waiting list who are compatible and who have been waiting the longest or have the greatest need.

How successful is kidney transplantation?

The results of kidney transplantation are generally excellent. For non-living donor transplants, about 85% to 90% of kidneys are functioning well at one year. For living donor transplants the success rate is about 90% to 95% at one year. And many transplanted kidneys have functioned well for more than a decade. If a transplanted kidney does gradually fail, you may need treatment such as dialysis or another transplant.

What complications are associated with kidney transplantation?

The major complication of kidney transplantation is organ rejection. Rejection occurs when your body recognizes that the transplanted kidney is foreign and the immune system produces antibodies that attack the transplanted kidney. Everyone with a transplanted kidney, except those receiving a kidney from an identical twin, needs to be on long-term treatment that suppresses the immune system (called immunosuppressive therapy), generally with corticosteroids (e.g., prednisone) and other immunosuppressive drugs (e.g., azathioprine, cyclosporine, tacrolimus, sirolimus, basiliximab, mycophenolate mofetil or MMF) to reduce the risk of rejection. Even with the use of immunosuppressants, 20 out of 100 people will experience at least one rejection episode within a year.

Most people with a kidney transplant will take 2 or 3 immunosuppressive medications. Your transplant team will determine which medications are best for you. Depending on your response and how well you tolerate the medications, your medications may be adjusted to better suit your needs. Your doctor and pharmacist will go over your medications, how to take them, and what side effects to watch out for.

Other than gradual failure of a transplanted kidney due to chronic rejection, the main complication from receiving a kidney transplant relates to the long-term effects of the immunosuppressive medications. Most of the immunosuppressants increase your risk of infection and some can increase the risk of some types of cancer (e.g., skin cancer, lymphoma). Talk to your doctor or pharmacist about any concerns you have about the long-term use of these medications.

Written and reviewed by the MediResource Clinical Team