About Kidney Transplants
A kidney transplant is a surgical procedure in which a healthy kidney from a donor is placed into a person whose kidneys have failed. The transplanted kidney takes over the work of filtering blood, removing waste, and balancing fluids — functions that dialysis can only partially replicate.
For many patients with End-Stage Kidney Disease (ESKD), a successful transplant offers a longer life expectancy, fewer dietary restrictions, greater energy, and freedom from the time demands of dialysis. However, transplantation is not right for everyone, and it requires lifelong commitment to immunosuppressive medications and follow-up care.
Pre-emptive Transplant: The best outcomes occur when a transplant is performed before dialysis is needed. If you have Stage 4 or 5 CKD, ask your nephrologist about a transplant evaluation now — don't wait until you start dialysis.
Who Qualifies?
Most people with kidney failure can be evaluated for a transplant. A transplant team will conduct a thorough medical and psychosocial evaluation to determine if you are a good candidate.
Generally Eligible
- Adults and children with ESKD or advanced CKD
- Patients on dialysis (hemodialysis or peritoneal)
- Patients not yet on dialysis (pre-emptive)
- Those in good enough overall health for surgery
- Patients with controlled chronic conditions
May Not Be Eligible
- Active cancer or recent cancer history
- Severe heart or lung disease
- Active infection or untreated HIV
- Active substance abuse
- Inability to comply with post-transplant care
Eligibility criteria vary by transplant center. Even if you have been told you are not a candidate, it is worth seeking a second opinion — criteria and medical circumstances change over time.
Types of Kidney Transplants
Living Donor Transplant
A healthy person — often a family member, friend, or altruistic stranger — donates one of their two kidneys. Living donor transplants have the best outcomes: shorter wait times, better kidney function, and longer graft survival.
- Can be scheduled in advance (no waiting list)
- Kidney begins working immediately in most cases
- Longer average graft survival vs. deceased donor
- Donor can live a normal life with one kidney
Deceased Donor Transplant
A kidney from a person who has recently died and consented to organ donation. Patients are placed on the national waiting list (managed by UNOS) and matched based on blood type, tissue type, time on the list, and medical urgency.
- Average wait: 3–5 years (varies by blood type & region)
- Must be available on short notice when a kidney becomes available
- Two subtypes: standard criteria and expanded criteria donors
- Paired exchange programs can reduce wait times
Paired Kidney Exchange
If a willing living donor is not a match for you, they can donate to another patient in exchange for a compatible kidney for you. Chains of paired exchanges can involve dozens of donor-recipient pairs across the country.
- Expands the pool of compatible living donors
- Coordinated through national exchange programs
- Can significantly reduce wait times
- Ask your transplant center if you qualify
The Transplant Process
The path to a kidney transplant involves several stages — from evaluation to surgery to long-term follow-up. Here is what to expect at each step.
Referral & Transplant Evaluation
2–6 monthsYour nephrologist refers you to a transplant center. The evaluation includes blood tests, imaging, cardiac testing, cancer screening, and psychosocial assessment. This process typically takes several weeks to months.
Waitlist Registration
OngoingIf approved, you are registered on the UNOS national waiting list. You may also be listed at multiple transplant centers simultaneously to improve your chances.
Finding a Match
VariableWhen a deceased donor kidney becomes available, UNOS matches it to the best candidate based on blood type, tissue compatibility, time on the list, and medical urgency. You must be reachable 24/7.
Surgery
3–4 hours surgeryThe transplant surgery takes 3–4 hours. The new kidney is placed in the lower abdomen. Your original kidneys are usually left in place unless they are causing problems. Most patients stay in the hospital 3–7 days.
Recovery & Monitoring
3–6 months intensiveThe first 3–6 months are the highest-risk period for rejection. You will have frequent clinic visits, blood tests, and close monitoring. Most patients return to normal activities within 4–8 weeks.
Long-Term Follow-Up
LifelongLifelong follow-up with your transplant team is required. You will take immunosuppressive medications every day for the rest of your life to prevent rejection. Regular labs and clinic visits continue indefinitely.
Life After Transplant
A successful kidney transplant can dramatically improve quality of life — more energy, fewer dietary restrictions, no dialysis schedule, and the ability to travel, work, and be active. But it also requires lifelong commitment.
Immunosuppressive Medications
- Must be taken every day — never skip doses
- Prevent your immune system from rejecting the kidney
- Common medications: tacrolimus, mycophenolate, prednisone
- Side effects include increased infection risk and some cancers
Diet After Transplant
- More liberal than dialysis diet — but still important
- Avoid grapefruit (interacts with tacrolimus)
- Limit sodium to manage blood pressure
- Food safety is critical — avoid raw/undercooked foods
Monitoring & Lab Work
- Frequent labs in the first year (weekly, then monthly)
- Monitor kidney function (creatinine, eGFR)
- Watch for signs of rejection or infection
- Annual skin cancer screenings recommended
Activity & Lifestyle
- Return to work typically within 4–8 weeks
- Exercise is encouraged — improves long-term outcomes
- Travel is possible — plan ahead for medications
- Pregnancy is possible but requires careful planning
Risks & Complications
Like all major surgeries, kidney transplants carry risks. Understanding them helps you make an informed decision and recognize warning signs early.
Rejection
- Acute rejection (first year)
- Chronic rejection (long-term)
- Treated with increased immunosuppression
- May require return to dialysis
Infection
- Higher risk due to immunosuppression
- Bacterial, viral, and fungal infections
- CMV and BK virus are common
- Preventive medications prescribed
Other Risks
- Surgical complications
- Delayed graft function
- Post-transplant diabetes
- Increased cancer risk (skin, lymphoma)
Warning signs of rejection: Decreased urine output, swelling, fever, pain or tenderness over the transplant site, or a rise in creatinine on lab work. Contact your transplant team immediately if you experience any of these symptoms.
Questions for Your Transplant Team
Am I a good candidate for a kidney transplant?
Should I pursue a living donor or wait for a deceased donor?
How long is the typical wait time for my blood type?
Can I be listed at more than one transplant center?
What does the evaluation process involve?
What medications will I need to take after transplant?
What are the risks specific to my health situation?
What happens if the transplant fails?
Can I still receive a transplant if I have diabetes?
What lifestyle changes will I need to make?