Living With CKD? Get the Facts About Kidney Transplants
The idea of needing an organ transplant can, very understandably, be daunting. But if you have late-stage kidney disease (CKD)—which is when your kidneys are so damaged they can no longer perform their duty of filtering waste from your blood—a transplant may be the best way to help alleviate your symptoms and lengthen your life. Even if you're in the beginning stages of your CKD diagnosis, this major surgery is something you might want to have on your radar—that’s why we’re bringing you 10 key facts you need to know now, including when a transplant may be necessary for CKD, what to expect from the process, follow-up care requirements, and more.
Kidney Transplant Is a Top Treatment for CKD
“Hands down, kidney transplant is the best option for treating chronic kidney disease,” says Nicole Ali, M.D., transplant nephrologist at NYU Langone’s Transplant Institute in New York City. “It increases life expectancy more than twice that of someone who remains on dialysis.” Dialysis is a procedure that helps filter your blood when the kidneys can’t do it themselves—but it only replaces part of your kidney function, according to the National Institutes of Health (NIH). “With kidney transplant, overall, the quality of life and life expectancy are much better,” she says.
You Must Meet Requirements to Get a Transplant
Your kidney function is measured by glomerular filtration rate (GFR), a blood test for the waste product creatinine, per the American Kidney Fund. Because CKD worsens your kidney health over time, GFR will continue to drop. “Many people need a transplant when kidney function is less than 15% of normal, or GFR is less than 15 ml/min,” explains Silas Norman, M.D., nephrologist at Michigan Medicine Transplant Clinic in Ann Arbor, MI. That said, you can qualify for the transplant list when your GFR is 20 ml/min or less because ideally you would get a transplant before your health is severe enough to need dialysis, he says.
Don't Wait to Get Evaluated
Getting evaluated for a transplant early is important with CKD, says Dr. Norman. “That gives people the best chance of getting a transplant. We need to see people ideally when their GFR is somewhere between 20-25 ml/min so that we can get them evaluated and get all their testing done so that if and when they progress to 20 ml/min, we’re medically ready for them to get on the waiting list,” he says. That’s why being proactive and working with your doctor to monitor the progression of your CKD is a must, even long before a transplant is actually needed.
There Are 2 Main Types of Kidney Transplants
With kidney transplants, you can either use a living donor kidney or get on the waitlist for a deceased donor kidney—but that waiting list can be years long (for example, it’s more than 5 years long in Michigan, Dr. Norman says). “That’s why many people with advanced CKD spend at least some time on dialysis, because the wait time is fairly long,” he says. “With a living donor, you’re more likely to get a transplant before you need dialysis.” Early evaluation for a transplant can also give you more time to consider the option of a living kidney donor, he adds.
Stay Healthy While on the Waiting List
If you’re not able to find a living kidney donor—typically a family member or close friend, says the National Kidney Foundation—then you’ll get placed on the deceased donor waiting list. The waiting list is driven by waiting time, he says—meaning whoever has been on it the longest generally gets the next transplant. “It’s very important that people stay as healthy as possible while on the list to remain as good a medical transplant candidate as possible,” says Dr. Norman. That means taking steps to maintain a healthy weight, stay active, and eat a balanced diet, he says.
You'll Have to Act Fast When You're Matched
Again, it can take years to move up the list for an available deceased donor kidney. But once you get matched with an organ, you’ll have to act quickly. “You’ll generally have less than an hour to decide if you’re interested and ready,” Dr. Ali says. If you agree, you’ll be admitted to the hospital, the organ will be transported there, and the process of surgery will begin, she says.
The Surgery Isn't What You Think
During the surgery itself, you may be surprised to learn that your surgeon won’t actually take out the original kidneys—those stay in your body, says Dr. Norman. “We place the donor kidney up front, low in the pelvis, so everything is close enough to the bladder,” he explains. Your surgeon will connect the new kidney to your blood vessels and bladder so it can start to filter blood, the NIH says. You’ll end up with a six-to-eight-inch incision on your lower abdomen, Dr. Norman says, and typically, you’ll be in the hospital for around three days. For people on dialysis before transplant, many are able to stop dialysis immediately after the surgery whereas some may need a few more dialysis treatments.
There Are Some Risks
As with any procedure, kidney transplant surgery isn’t totally risk-free, says Dr. Norman. “Bleeding risk and some infection risk are similar to any other abdominal surgery,” he explains. “Typically, it goes very well. The most important thing, like any other surgery, is to make sure you’re the best possible surgical candidate—for example, having a healthy weight.” And not everyone with advanced CKD will be a good candidate for kidney transplant, says Dr. Ali: “There are some patients who are debilitated or with severe heart or lung problems that may not do well with the surgery and recovery.”
Follow-Up Care After Transplant Is Lifelong
Kidney transplants are life-saving procedures—and they require lifelong follow-up, too. “There’s intense follow-up in the first one-to-three months, with often weekly visits to the transplant center,” Dr. Norman says. You’ll get regular blood draws to closely monitor your health, and you’ll also be put on lifelong medications to prevent your body from rejecting the transplant. “It’s important that people are very consistent with their medications and follow-up visits,” he says. Most transplant centers have whole teams—including nutritionists, pharmacists, and nurses—dedicated to making sure you understand how to properly care for your health after transplant, says Dr. Ali.
Your Risk for Infection Is Higher Post-Transplant
It’s important to understand that the lifelong medication you’ll take to prevent transplant rejection reduces the ability of your immune system to fight off infection, according to the National Kidney Foundation. “For example, the most common infection after transplant is a urinary tract infection (UTI),” says Dr. Ali. “We do know that our patients do worse with infections than non-immunosuppressed people,” she says. That’s why you’ll need to be extra diligent about staying healthy post-transplant. Getting your regular vaccines (like the flu shot) and washing your hands frequently are key steps to prevention infections, from the common cold to COVID-19.
The Bottom Line on Kidney Transplants for CKD
If you have advanced CKD, a kidney transplant is often the top option to help you live a longer, healthier life. Being proactive about managing your CKD long before a transplant may be needed will help ensure you have the best chance possible to receive this treatment—and that means getting evaluated for a transplant sooner rather than later. “Patients can actually refer themselves to a transplant center for transplant evaluation—they don’t need to wait for doctor to do so,” Dr. Norman says. “It’s very important that patients are able to be their best health advocates.”
- Care After Kidney Transplant: National Kidney Foundation. (2019). “Care After Kidney Transplant.” kidney.org/atoz/content/immunosuppression
- Kidney Failure Treatments: National Institutes of Health. (2018). “Choosing a Treatment for Kidney Failure.” niddk.nih.gov/health-information/kidney-disease/kidney-failure/choosing-treatment
- Living Kidney Donor Information: National Kidney Foundation. (2019). “General Information on Livng Donation.” kidney.org/transplantation/livingdonors/general-information-living-donation
- Stages of CKD: American Kidney Fund. (2020). “Stages of Chronic Kidney Disease (CKD).” kidneyfund.org/kidney-disease/chronic-kidney-disease-ckd/stages-of-chronic-kidney-disease/