Kidney transplants

Unfortunately, not everyone is a suitable candidate for a transplant.

To be eligible for a kidney transplant, you need to be reasonably healthy. Surgery and the medication used to prevent rejection can place a strain on your body and cause problems if you are not well. Discuss with your doctor if a transplant is a good solution for you, or whether another treatment option would be better.

Before a transplant can occur, there are certain medical tests used to assess your health. These can include:

• an appointment with the transplant assessment team, which includes discussions and a physical examination
• blood tests
• x-rays of the heart and lungs
• ultrasounds and other imaging of the heart to ensure it's health
• a surgical review of your arteries, veins and bladder
• skin examination
• dental examination
• other specialised tests based on your personal health history
• periodic tests to make sure that you have not built up anti-bodies

In Australia, kidney transplants have a high success rate - currently, over 94% of transplants are working one year later.

Life expectancy for someone who has undergone a kidney transplant varies by each individual patient and their overall health. Currently, patient survival is at 91% for 5 years and 46% for 20 years for first transplants from deceased donors. The numbers for second and subsequent transplants are similar.

For transplants from live donors, survival rates are currently 96% at 5 years and 67% at 20 years, according to 2019 statistics from ANZSN.

There are two main types of transplant in Australia; those from a deceased donor and those from a living donor.

A kidney may be specifically given to you from a loved one, or in some rare cases, a kidney may be given to you by a stranger who altruistically donates one of their kidneys to the next suitable person on the waiting list.

Unless you have someone giving a kidney directly to you, you'll need to be placed on the official waiting list. This will be assessed through your renal unit or nephrologist and team. In Australia, the median wait time for a kidney transplant is around 2.2 years, but it's not uncommon for people to wait for up to 7 years.

Preparing for a kidney transplant can be overwhelming.

Before you head into surgery, make sure to talk to your doctor or health practitioner and ask them any questions you have. You will also need to speak to your carer, if you have one, and make plans with your school or workplace for initial changes to your daily life.

It's important to be as fit and healthy as possible too. You want to make sure your body is ready for both the surgery and medication you'll need to go on afterwards.

It's also a good idea to have regular health and dental checks, and maintain your:

• recommended dietary and fluid restrictions
• dialysis schedule
• regular fitness or exercise plan
• ideal body weight for your age and size (being overweight increases the risk of problems during surgery).

During surgery, the new kidney is placed in position. Your existing kidneys are not usually removed. Sometimes, if you have large polycystic kidneys, one may be removed to make space for the transplant.

The operation usually takes 3 to 4 hours with variable hours of recovery. The new kidney is connected to your bladder so urine can flow, and a tube or catheter is placed in your bladder for up to 5 days (after which it's removed). You may come out of the operation with tubes at the operation site (a drain) or a catheter in your bladder.

Some kidneys start to work straight away, but others may take a few days or weeks. You'll be in hospital for about a week, depending on how quickly you recover from the surgery. The transplants kidney will be closely monitored with blood tests and scans. You may also be required to undergo a transplant biopsy where they take a small sample of the tissue.

You will need ongoing frequent monitoring of blood tests, blood pressure, drug levels and your health. Initially this will be very frequent (daily) and over time will become less frequent depending on your progress. Be prepared to come into the hospital daily after discharge.

You'll take medications, for the life of the transplanted kidney, to stop your body from rejecting it. These medication can make you more prone to serious illnesses such as infections and cancers.

Sometimes a kidney stops working because people stop taking these medications, so it's incredibly important that you take them regularly and a s prescribed. Along with general health and fitness, your kidney will last longer if you follow advice about caring for your kidney.