1. R E N A L R E S O U R C E C E N T R E
An Introduction to
Kidney Transplantation

3. An Introduction to
Kidney
Transplantation

4. This publication has been sponsored by an educational grant from Roche.
An Introduction to Kidney Transplantation
© 2009
RENAL RESOURCE CENTRE, 2009
37 Darling Point Road
Darling Point NSW 2027
Telephone: +61 2 9362 3995 or
+61 2 9362 3121
Freecall: 1800 257 189
Facsimile: +61 2 9362 4354
renalresource@nsccahs.health.nsw.gov.au
www.renalresource.com

5. Contents
Why Have a Kidney Transplant? ..................................................................... 1
Where are Kidneys for Transplantation Obtained .............................................. 2
Kidney Transplantation Success Rates ........................................................... 3
Preparing for a Kidney Transplant ................................................................... 3
How You Can Prepare? ................................................................................. 5
Kidney Transplantation ................................................................................. 7
Post-Transplant Care .................................................................................. 10
Medications Used in Kidney Transplantation ................................................. 11
An Unsuccessful Transplant ......................................................................... 11
Emotional Changes To Expect ..................................................................... 11
Going Home With A Successful Transplant .................................................... 13
Life with a New Kidney ............................................................................... 14
The Renal Team ........................................................................................... 14
Living Donor Kidney Transplantation .............................................................. 15
New Developments in Live Donor Transplantation ........................................... 18
Recipient, Donor and Family Concerns About Live Kidney Donation ................... 19
Long Term Effects for Donor .......................................................................... 20
Combined Renal and Pancreas Transplantation ............................................. 20

6. An Introduction to Kidney Transplantation
page 6

7. Why Have a Kidney Transplant?
A kidney transplant involves taking a kidney from the body of one person
and implanting it surgically into the body of someone who has lost kidney
function. The transplanted kidney can then perform the function of that
person’s own kidneys.
Whilst a transplant is not a cure for renal (kidney) failure, it does allow patients
to live a more “normal” life than that experienced on dialysis. Patients with a
well-functioning transplant have a greater sense of well being and are able to
enjoy a lifestyle free of dialysis treatments, although they must continue with
their transplant medications.
A transplant can mean improvement in anaemia, bone disease and in
children, body growth. It also offers freedom from previous dietary and/or fluid
restrictions and from restrictions on time and mobility.
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8. An Introduction to Kidney Transplantation
Where are Kidneys for Transplantation Obtained?
Kidneys are donated by live donors and deceased donors.
Live Donors
For many years, most live donors were closely related to the potential recipient,
such as a brother, sister or parent. Such close relatives were likely to be a close
tissue match to the recipient, resulting in excellent outcomes. With the advent of
improved immunosuppressive medications, it is now possible to achieve similar
outcomes using live donors who are unrelated to the recipient. Spouses, more
distant relatives and close friends can also have a compatible blood group and
tissue matches to the potential recipient. Many live donor transplants are performed
using such unrelated donors. It is now also possible for altruistic members of the
community to be assessed for their suitability as anonymous live kidney donors.
These people are known as “non-directed kidney donors”.
Deceased Donors
Kidneys from deceased donors are allocated to the best tissue matched patients on
the transplant waiting list. Potential deceased donors are screened for cancer and
transmissible viruses and their medical history is fully evaluated. Deceased Donors
can be heart-beating or non heart-beating.
Heart-Beating Donors
These donors have suffered severe trauma to the brain either by fatal head injury,
such as in a motor vehicle accident or through a cerebral (brain) hemorrhage. In
order to be considered as organ donors, these patients must be ventilated in an
intensive care unit and medically certified as “brain stem” dead, meaning that all
function of the brain has ceased. In other words, life cannot be sustained. Heart
beat and lung function are artificially maintained by a respirator. A very small
proportion of all deaths in hospitals occur under these conditions.
Non Heart-Beating Donors
As the number of donors drawn from those who are brain stem dead is very limited,
renal units also perform transplants from donors without a heartbeat, i.e. these
donors have been cared for in intensive care units and are referred to as “non
heart-beating” donors or “donation after cardiac death” (DCD) donors.
Preliminary studies indicate that although these kidneys may have initial delayed
graft function, there does not appear to be any difference in long-term graft survival
between kidneys from donors with a heartbeat and those without a heartbeat.
page 2

9. Kidney Transplantation Success Rates
The success rate of the transplanted kidney one year after transplantation
(one year graft survival) of live donor kidneys is 97% and for deceased donor
kidneys, is 91% (ANZDATA 2007). Five year graft survival for live donor kidneys is
88% and for deceased donor kidneys, is 82%.
If the transplant works well for the first year, the chances are good that it will
function for many years. If the transplant fails, a second transplant is possible
and can be entirely successful. Many patients who received renal transplants
25-35 years ago remain well with those original grafts. The average transplant
graft survival is 15 years.
The refinement and development of new immunosuppressive medications has
consistently improved the success of kidney transplantation.
Preparing for a Kidney Transplant
Who is Eligible?
Many people with kidney failure requiring dialysis can be considered for
transplantation. Apart from having kidney failure, these people must be in relatively
good health and willing to undergo the procedures involved. For people with other
major medical problems, such as severe heart and vascular disease, there may
be increased problems for transplantation and dialysis may be a better treatment
option. Some people are happy with their dialysis treatment and do not wish to
undergo transplantation. Each patient should discuss their own medical suitability
with their renal physician (kidney specialist).
Donor and Recipient Matching
Donor and recipient matching can be divided into three distinct areas: blood
group matching, tissue type matching and cross matching. Each of these is
an important aspect of donor and recipient matching and applies to living kidney
donation and deceased kidney donation.
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10. An Introduction to Kidney Transplantation
1. Blood Group In the case of a deceased donor, the ordinary blood groups
(A, B, AB, O) match the red blood cells of donor and recipient and must be
compatible, as for blood transfusion. In the case of a live donor, some ABO
incompatible transplants are possible.
2. Tissue Typing This involves matching of a type of white blood cell called
“lymphocytes”. These cells (in fact, all body cells) have special markers
called antigens on their surfaces. It is now known that a special group of
these antigens, called HLA (Human Leukocyte Antigens) are important in
transplantation. The closer the match of antigens between patient and donor,
the better the chance of a successful transplant.
Since these antigens are inherited from parents, each child inherits half of their
antigens from each parent. Therefore, if a parent is the prospective donor for
the child, they will share at least one half of the antigens. For siblings (brothers
and sisters) of a recipient, the chances of a match are: 25% will have full
match, 50% will have a half match, 25% will be completely mismatched.
3. Cross Match Just prior to the transplant, blood is taken from donor and
recipient and mixed to ensure no reaction, i.e. negative cross match. In the
case of a deceased donor, the transplant will not proceed if there is a positive
cross match. In the case of a living donor, new approaches may enable the
transplant to proceed (see page 18)
The Transplant List
People waiting for a deceased donor kidney in Australia have their tissue typing
recorded on a centralised computer list. Whilst tissue typing is done once, blood
is taken monthly to cross match against donor blood if a donor kidney becomes
available. This is because new antibodies can be formed e.g. after blood transfusion
or after exposure to infection, which may lead to a positive cross match with the
donor. When a kidney becomes available, the donor tissue typing is entered into the
computer and matched with the most suitable recipient, who will then be offered a
transplant. Because of the many possible tissue types, a patient’s name may not
come up for months or years. This is often frustrating and many people feel they
may have been forgotten. However, it is important that the tissue type is as closely
matched as possible, as this will help to reduce the possibility of the transplant
being rejected. If two people have the same degree of tissue typing, the kidney
is first offered to the person who has been on dialysis longer. It is important that
patients’ blood samples are sent to the tissue typing laboratory each month, so
that they remain active on the waiting list.
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11. Pre Transplant Preparation
Medical Investigations are necessary to ensure fitness for transplantation. These
may include physical examination, blood tests, x-rays of heart, lungs and sometimes
stomach and bladder. It is also important that any infections are treated before
transplantation. Patients being considered for transplantation are reviewed by the
transplant physician and the transplant surgeon.
How You Can Prepare
Maintaining good health is vital preparation for a kidney transplant. As well as
keeping generally fit, controlling weight and blood pressure, there are a number of
important preparations:
Smoking, Drug and Alcohol Use The use of tobacco and other addictive and
mood altering drugs should cease so that your physical and mental health are in
the best possible condition. Alcohol use must be moderate: two standard drinks per
day (males) and one standard drink per day (females) with two alcohol free days per
week.
Dental Care Regular dental checks are essential, as risk of mouth infection after
transplantation is increased if teeth and gums are in poor condition.
Dialysis As most people with kidney failure are on dialysis prior to transplantation,
maintaining the dialysis schedule is an important part of the preparation.
Weight Controlling both body weight and fluid weight (i.e. not gaining too much
weight between dialysis treatments) is important in order to be ready when a
transplant becomes available.
Protection of Skin Against Sunlight This is particularly important for people
who do not have dark skin and will help prevent skin cancer after transplantation.
Blood Pressure Good blood pressure management contributes to positive
outcomes for dialysis and transplant patients. It is absolutely vital to ensure good
blood pressure control.
Exercise Regular exercise under the supervision of your renal physician. is very
important. It improves recovery time, blood pressure control, mood and general well
being. For example, 30 minutes walking 3-4 times per week.
Cancer Screening Regular pap smears and mammograms are recommended
for women every 2 years.
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12. An Introduction to Kidney Transplantation
page 6

13. Kidney Transplantation: What to Expect
The Phone Call
The phone call notifying the patient of an available deceased donor kidney can
come anytime - day or night. It is important to be prepared for this, i.e. have
arrangements made so that you are able to be contacted readily and can come
straight to the hospital so that the transplant can be performed as soon as
possible. This is necessary because of the time limitation in keeping the kidney
healthy after it has been removed from the donor.
Once at the hospital, a thorough medical examination is carried out to determine
fitness for surgery. This will include blood tests, x-rays an ECG and dialysis if
necessary. Occasionally, it is necessary to cancel the surgery after arriving at
the hospital. This may occur for unforeseen reasons - such as the patient has an
infection or the kidney shows signs of deterioration or is less well matched than
expected. This usually only occurs in kidneys coming from far away, e.g. from
interstate, where the final cross match on the monthly blood is only done when the
kidney reaches your city.
Consider where you will stay after discharge from hospital – it may be necessary to
attend the transplant clinic daily for 2-4 weeks to ensure any rejection is detected
early and treated. Gradually, your visits will become less frequent as your kidney
function stabilises.
The renal unit social worker can advise about local short-term accommodation, if
you live a very long distance from the transplant unit. Travel and accommodation
assistance schemes are available to assist rural patients.
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14. An Introduction to Kidney Transplantation
The Transplant Operation
The transplant operation takes around 3-4 hours. The transplanted kidney is placed
on the right or left side of the lower abdomen, below the navel (see Diagram 1).
The new kidney’s artery and vein are joined to an artery and vein in the pelvic
area. The ureter (urine drainage tube) from the kidney is attached to the bladder.
Many patients are surprised to learn that their failed kidneys are not removed but
left to continue whatever small amount of function they may still have. However,
if the failed kidneys must be removed, a separate operation is necessary prior to
transplantation. This is only rarely required e.g. in the case of chronic infection or
very large kidneys.
Blood Supply
Kidney
Kidney
Transplant Ureter
Urinary Bladder
Artery
to Leg
Diagram 1 Transplanted Kidney
page 8

15. After the Operation
After surgery, there is usually some pain around the operation site, which will be
relieved by medication. A bladder catheter and drainage tubes from the wound are
needed for about a week to assist healing. The amount of urine produced by the
new kidney is very closely monitored and measured. Recovery from the transplant
operation is usually fairly rapid; patients are out of bed on the day after the
operation and are able to move around in a few days. A nuclear medicine scan and/
or ultrasound test may be done early and repeated to assess kidney function.
The Transplant Ward
In many hospitals, new transplant patients are cared for in a separate area or ward
from other patients. It is sometimes necessary for transplant patients to be nursed
in this area since the medications taken to prevent rejection of the new kidney also
make patients susceptible to infection. For this reason, the number of visitors may
be restricted. In some transplant areas flowers and fruit are not permitted, as they
may harbour bacteria.
It is not unusual for kidney function to be slow in starting, especially for deceased
donor kidneys. This delay in function is usually caused by temporary damage
to the kidney cells and the kidney may take 3 weeks or even longer to recover.
Sometimes, the kidney may function briefly, then stop again due to temporary
damage. If the kidney does not function well immediately following transplant, it
does not mean it will not function satisfactorily in time. Dialysis may be necessary
for days or weeks until kidney function is sufficient to keep the body in good
chemical balance.
Hospitalisation
The length of stay in hospital depends on how well the kidney works and the
occurrence of any complications. Average stay is about 1-2 weeks but may be up to
4 weeks.
After discharge from hospital, it may be necessary to return daily as an out-patient
for some weeks. These visits decrease in frequency as kidney function stabilises.
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16. An Introduction to Kidney Transplantation
Post-Transplant Care
Possible Complications Post-Transplant
Rejection
The body resists the presence of foreign cells or tissue of a donor kidney in much
the same way that it fights off bacteria and viruses which cause illness. The
rejection process occurs when the patient’s white blood cells reduce or stop the
function of the transplanted kidney. Some patients experience a rejection episode
in the first few weeks after their operation. Symptoms of rejection may include
fever, decreased urine output, fluid retention and increase in weight, tenderness
over the kidney and elevated blood pressure. Most rejection episodes can be
reversed with drug treatment.
There are three types of rejection:
1. Hyperacute Rejection – can occur minutes or hours after the transplant.
This type of rejection is very rare. It is untreatable and the kidney is removed
immediately.
2. Acute Rejection – can occur at any time from a week to a year after transplant.
Occasionally, it can occur some years after transplant. This form of rejection is
experienced by most transplant patients and is usually treatable. It is certainly
likely to occur if the drug treatments prescribed are not taken regularly.
3. Chronic Rejection – occurs slowly over a long period of time and there may
be no obvious symptoms. Chronic rejection is also difficult to treat. If the
transplanted kidney eventually stops working, the patient will require dialysis.
Another transplant is possible and your renal physician will discuss this option.
Infection
Because the drugs used to prevent and control rejection also weaken the body’s
defences, patients are more prone to infection after transplant. Risk of infection
commonly in the wound site, mouth, urinary tract and lungs is highest in the first
few months after transplant because drug dosage is highest. This is the reason for
strict infection control in the transplant ward. Whilst some infections can be very
serious, most are controlled by antibiotics and/or reducing doses of anti-rejection
drugs.
Most units prescribe medications to prevent particular high risk infections after
transplantation.
Surgical Complications
Slow wound healing can be caused by some medications, diabetes and obesity.
Those at risk are closely monitored.
page 10

17. Medications Used in Kidney Transplantation
In order to control rejection, a combination of medications is given which suppress
or reduce the effectiveness of the body’s immune system. These medications
are called immunosuppressives and must be taken throughout the life of the
transplanted kidney.
The renal physician will determine which medications and dosages are needed.
Dosages are very large at first to prevent rejection and are gradually reduced as the
kidney begins to function well. These medications have a number of side effects,
which usually subside as drug dosages are lowered. Each patient’s experience of
side effects is individual and each patient is monitored very closely in the post-
operative period.
An Unsuccessful Transplant
If the kidney does not function in spite of all the medications given, it will be
removed and dialysis treatment resumed. If one kidney is rejected, a second
transplant will not necessarily also be rejected. Patients are usually able to go back
on the transplant list once they have recovered.
Emotional Changes to Expect
Just as transplantation involves many physical changes to the body, emotional
changes are not unusual. It is an extremely exciting time but it can also be a time
of great anxiety as the patient and family and more commonly live donor, wait for
the kidney to start functioning and for blood results and overall health to improve.
Anxiety about possible rejection and infection is normal and patients may find the
isolation from family and friends difficult. The anti-rejection medications may initially
cause some physical changes and mood swings. Alternating feelings of elation,
depression and irritability are common.
Some of these feelings may be offset by an increased sense of well-being as the
transplant begins to function. However, with so many changes occurring so quickly,
the patient and family may sometimes feel overwhelmed with anxiety and fear. It
is important during this time to share these feelings with someone close and to
discuss your concerns with your physician and other staff. They understand this can
sometimes be an extremely tense time and will always try to anticipate your fears
and disappointment, especially if the kidney is slow to function and dialysis is still
necessary, even if only for a short time.
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18. An Introduction to Kidney Transplantation
page 12

19. Going Home with a Successful Transplant
Leaving hospital with a new kidney is an exciting time but contact with the
transplant unit does not end upon discharge from hospital. In the first few months
after discharge from hospital, frequent visits to the transplant renal physician are
required. Daily visits for the first few weeks are common. This is so the physician
can closely monitor the transplanted kidney’s function and any signs of infection or
rejection. It is therefore necessary for patients from rural and remote areas to stay
in accommodation close to the hospital for some time after the transplant surgery.
Clinic visits become less frequent as kidney function stabilises and general health
improves. Follow-up for rural patients can also be maintained through the local
doctor and renal physician..
There are a number of important precautions that every transplant patient must
observe when returning home:
Medication Management A very important part of treatment is taking the
medications in the dosages prescribed by the doctor daily and for the life of the
transplant.
Avoid Sources of Infection For a short period immediately after the transplant,
it is suggested that patients avoid crowded places and people with colds or viruses
(especially small children). Good hand washing and treatment of scratches helps
prevent infection. Chicken Pox is very contagious and dangerous. Vaccination prior
to transplantation is recommended.
Skin Care The drugs given will make the skin very sensitive to the sun. The
incidence of skin cancer is very high in transplant patients, so it is essential to
wear protective clothing and SPF 30+ sunscreen when outdoors. Reapply the
cream regularly.
Report Any Illness This is particularly important in the first year. Prompt
treatment of any problems can prevent further complications.
Diet Whilst the diet is relatively free of restrictions, transplant medications increase
the appetite, making it difficult to control weight gain. Food hygiene and avoiding
foods that contain large amounts of bacteria (eg: pate, soft cheeses. salami, raw
seafood) is important. The renal dietitian is available to advise on a healthy and
satisfying diet.
Risks There is a 1% per annum risk for each patient of a non-skin tumour. Regular
cancer screening is advised.
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20. An Introduction to Kidney Transplantation
Life with a New Kidney
A kidney transplant can offer a “new lease of life” for patients and their families.
There are some readjustments in the first year after transplant, and maybe a degree
of anxiety about how long the kidney will function. As time goes on, these feelings
usually decrease.
Most people are able to return to normal activities and work within 3 to 6 months
after transplant. Exercise (gentle at first) is also an important part of toning muscles
and maintaining good health.
For many people, sexual function improves after transplant. Sexual activity will not
harm the transplanted kidney nor increase risk of infection. However, as is the case
for any major surgery, it is advisable to wait about four weeks before having sexual
intercourse.
Having a baby after receiving a kidney transplant is possible but not usually
advised until at least 1-2 years of good kidney function. The need for contraception
should be discussed with your doctor. There are considerably increased risks of
pregnancy complications, such as premature births and hypertension in women who
have kidney transplants. Careful monitoring of the pregnancy is needed. Couples
considering pregnancy should seek advice from their doctor, as x-rays and other
tests might be necessary and preferably done before the pregnancy.
The Renal Team
It should now be clear that deciding to have a kidney transplant is a major decision.
The patient and family are advised to discuss all the practical and emotional
issues together. The renal team, consisting of physician, surgeons, nursing staff,
dietitian and social worker are available to talk over all aspects of transplantation.
Many units also offer regular transplantation information workshops, which can
complement the discussions with members of the renal team.
page 14

21. Live Donor Kidney Transplantation
General Issues
In the 1960’s, most renal transplants performed in the United States were from
live donors. For many years, the majority of transplants performed in Australia
were from deceased donors. However, the increasing gap between the number of
potential recipients and donated kidneys has led to a steady increase in live donors
in Australia. Around 50% of all transplants performed in Australia now use live
donors.
The issue of donating a kidney is a difficult one for patient and family. Both are likely
to have mixed feelings. Most patients are hesitant about asking a family member to
donate a kidney and family members may be concerned about the risks involved for
them. Questions often asked are: Would I be a suitable match? What will happen
to my other kidney? What will the surgery be like? Would I have to take much time
off work and other activities? The following information attempts to address their
concerns.
Advantages for a Live Donor Recipient
1. Transplantation may sometimes be possible before dialysis is commenced
(pre-emptive transplantation).
2. Time dependent on dialysis is reduced. This is particularly important for people
with diabetes and young children.
3. Transplant surgery can be planned to suit the donor and recipient.
4. In the case of well matched donors, the recipient may require less
immunosuppressive medication.
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22. An Introduction to Kidney Transplantation
Who can be a Live Donor?
Live donors can be related or unrelated to the recipient and can be of a different
sex. Prospective donors must be an adult (over the age of 18 years) and be in good
health.
A close blood relative, such as a brother, sister, parent or child may be a suitable
donor as well as less immediate blood relatives, such as cousins, uncles, aunts,
nephews and nieces. Brothers and sisters may be a half or perfect match and
parents can be a half match. Unrelated donors include spouses, friends, in-laws,
distant relatives and altruistic members of the community, known as non-directed
donors. It is also possible to match perfectly with an unrelated donor, although a
perfect match is not necessary for a successful transplant.
What Tests are Necessary?
Blood tests are performed to determine if a donor and patient are a suitable
match. If recipient and donor are compatible, further extensive medical screening
is necessary. This includes x-rays and renal function tests to determine whether the
donor’s kidneys and urinary system are healthy. Potential donors are assessed by
their own, independent renal physician. If other health problems such as diabetes,
heart or lung disease present, the transplant will not proceed.
Preparation for Surgery
Prospective donors will be advised to minimise health risks by not smoking,
achieving a healthy weight and ceasing oral contraceptives three months prior to
surgery.
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23. page 17

24. An Introduction to Kidney Transplantation
New Developments in Live Donor Transplantation
ABO Blood Group Incompatible and Positive Cross Match Transplants
Both ABO blood group incompatibility and positive cross matching had previously
precluded transplantation, with a high risk of very rapid severe rejection and
destruction of the kidney within hours or days, in a process known as acute
rejection. Over 30% of patients with a potential live donor have blood group
incompatibility or a positive cross-match with their intended donor. Over 35%
of potential live donors have been unable to donate because of blood group
incompatibility with the intended recipient.
Recent advances now make ABO blood group incompatible and positive cross
match transplants possible for suitable patients. The key elements to success
appear to be combining techniques before and after the transplant that remove
naturally occurring and blood group antibodies, while also preventing new antibodies
being formed by the recipient. Recent studies reveal similar short and long-term
patient and graft survival as observed in blood group compatible transplantation.
Several transplant units in Australia have started performing such operations. In the
event that you have an incompatible or positive cross-matched donor, your renal
physician will advise if this procedure is suitable for you.
Paired Kidney Exchange
The Australian Paired Kidney Exchange Program (AKX) is a nationwide live kidney
donor program, established by the National Organ Donation and Transplantation
Authority to increase available organs from live donors. The goal of AKX is to
increase live kidney donor transplants by identifying matches for incompatible
donor-recipient pairs. Approximately 30% of potential donors fail to fulfil their wish
to donate a kidney to a relative or friend due to incompatible blood group or tissue
matches.
Paired kidney exchange involves pairs who are either incompatible or mismatched
by blood group or tissue type to be exchanged or swapped. The potential recipient
and their kidney-donating but incompatible partner are matched with another pair in
the same situation. The donors in each pair donate to the matching recipient in the
other pair. In a four-way operation, a kidney would be removed from each donor and
given to the other person’s partner.
Should you wish to register with AKX and participate in this program, contact your
renal physician.
page 18

25. Recipient, Donor and Family Concerns About
Live Kidney Donation
When and if a family member decides to donate a kidney, the decision to donate
must be voluntary and free of feelings of being “pressured”. It is important for
the donor to discuss their intention with their immediate family and the potential
recipient.
Sometimes, for a variety of reasons, family members and/or the patient may be
opposed to the donation. The process is often complex and so it is essential
to work through these issues with staff who can assist. Feelings and concerns
about the donation should be discussed in confidence with the renal physician,
social worker or psychiatrist caring for the donor. The patient should have similar
discussions with their renal team. Every prospective donor has the right, after
consideration of all the facts to withdraw the donation, just as every recipient has
the right to refuse the donation.
The Operation for Live Kidney Donors
When all tests have been completed, a date for the transplant surgery is scheduled.
Both donor and recipient go to the operating theatre at the same time. Following
the surgery, the donor will be cared for in a surgical ward. The recipient will be cared
for in a separate transplant ward, to minimise the possibility of infection.
Donor surgery can be performed as either an open procedure, involving a large
incision under the ribs or increasingly, as laparoscopic (keyhole) surgery,
involving much smaller incisions in the abdomen. A camera is used to guide the
removal of the kidney through a much smaller incision. The transplant surgeon will
advise if this procedure is possible.
Laparoscopic surgery provides the donor with a faster, easier and less painful
recovery from surgery. Donors can be discharged from hospital 2-4 days after the
surgery. They can usually return to work within 4 weeks of surgery but should avoid
any heavy lifting during those first 4 weeks. Open surgery requires a hospital stay of
about one week. Heavy lifting must be avoided for about 12 weeks.
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26. An Introduction to Kidney Transplantation
Long-Term Effects for Donor
Most kidney donors recover quickly after the surgery and are able to resume work
and other activities in 4-6 weeks. Resuming active sports will take longer.
Living with one kidney does not interfere with a woman’s ability to have children
and does not change life expectancy or increase the risk of acquiring kidney
disease. Long term follow up with annual blood pressure, blood and urine testing is
recommended.
Giving a kidney can be a very rewarding and satisfying experience for both donor and
recipient, providing considerable forethought is given. Renal unit staff will provide you
with all the information and counselling needed to make this decision.
More detailed information on the process of living kidney donation is available in
“Kidney Donation by Live Donors”, produced by NSW Health and available from
transplant units or the Renal Resource Centre.
Combined Renal and Pancreas Transplantation
In people with renal failure due to the complications of diabetes (diabetic
nephropathy) and for whom renal transplantation is being considered, a combined
renal and pancreas transplant is a possibility.
Combined renal/pancreas transplantation in Australia has been possible since
1987 and several hundred have been performed since then. The group of patients
considered suitable for the combined procedure are those:
a) with diabetes mellitus who are insulin dependent (Type 1 Diabetes)
b) with impending renal failure or on dialysis, requiring a renal transplant
c) aged less than 50 years with no heart disease
In conjunction with the above requirements, individual suitability is determined
through a number of medical, surgical and nursing assessments. The transplant
work-up involves an assessment of the diabetic changes within the blood vessels,
eyes, nerves and kidneys. This work-up is required both to exclude life threatening
contra-indications to the operation and to assess the value of any benefits that may
be gained through the addition of a renal/pancreas transplant. There are a number
of potential benefits that may be gained from this procedure. However they are quite
variable from person to person and should be discussed on an individual basis.
Combined transplants are performed in Australia at the National Pancreas Transplant
Unit at Westmead Hospital in New South Wales and at Monash Medical Centre in
Victoria. Further information on this procedure and eligibility requirements can be
obtained from your renal physician.
page 20

27. The Renal Resource Centre is a
national unit established to provide
information and educational materials
on kidney disease for patients and
health professionals.
The primary objective of the Centre An Introduction to
is to ensure that patients have easy Kidney Transplantation
access to such information, are well
informed and can actively participate in
their own health care.
The Renal Resource Centre is
committed to providing education and
service to the renal community.
RENAL RESOURCE CENTRE, 2009
37 Darling Point Road
Darling Point NSW 2027
Telephone: +61 2 9362 3995 or
+61 2 9362 3121
Freecall: 1800 257 189
Facsimile: +61 2 9362 4354
renalresource@nsccahs.health.nsw.gov.au
www.renalresource.com
page 21

28. RENAL RESOURCE CENTRE
37 Darling Point Road
Darling Point NSW 2027
Telephone: +61 2 9362 3995 or
+61 2 9362 3121
Freecall: 1800 257 189
Facsimile: +61 2 9362 4354
renalresource@nsccahs.health.nsw.gov.au
www.renalresource.com