Frequently Asked Questions

Aadil Institute of Nephrology Urology and Transplantation
There are three treatment options prescribed the world over (1) Hemodialysis (2) Peritoneal Dialysis (3) Kidney Transplant
In Hemodialysis blood is passed through a dialysis machine and filtered in the same way as done by functioning kidneys. This process cleans the blood of impurities.
Peritoneal dialysis works by passing special fluid into the abdomen. Some of the toxic chemicals in the blood pass into the fluid. After a couple of hours the fluid is drained along with the toxins.
The major function of your kidneys is to filter out impurities from your blood. When kidneys don’t work, we use a dialysis machine to filter out the impurities since your kidneys aren't able to do so.
After kidney failure begins, we monitor the serum Creatinine levels. If they reach a certain point, we consider dialysis.
Most patients get dialysis three times a week.
Yes, this can be done, and around 25 percent of our patients are dialyzed this way. This possibility should be discussed with a doctor when considering dialysis as an option. Most patients who do dialysis at home would often have to travel a long distance to get to a dialysis center.
The experience varies from patient to patient. Some do well on dialysis and some do not do well. Dialysis is always better than the alternative of death, but it is not as good as getting a transplant.
Kidney Transplant is the final means of replacing a failed kidney.
When a patient has kidney failure, it causes him or her to feel ill. Over time, waste products and fluid buildup in the body. This may result in death if untreated. There are three treatment methods for patients with End Stage Renal Disease (ESRD). (1) Hemodialysis (2) Peritoneal Dialysis (3) Kidney Transplant
Start the transplant evaluation process when you and your Nephrologist (kidney specialist) think that your kidney disease will eventually require dialysis. Begin by contacting the Nephrologist at Aadil Hospital and scheduling an evaluation. Please bring all previous medical record for evaluation Nephrologist. After meeting you and reviewing several important medical tests, the transplant team will determine if you are eligible or not eligible for a kidney transplant through Transplant coordinator.
No, kidney transplant is a big undertaking. Please discuss this in detail with transplant Coordinator. A transplant involves an operation, and requires you to take medications to stop your body from rejecting the new kidney. For some people—such as those with serious heart disease—the operation and/or the side effects of the medications are too dangerous. Kidney transplantation is too hazardous for patients with conditions such as active infections and cancer.
Kidney Transplantation is the treatment of choice for people with kidney failure. This allows patients to stop dialysis, decrease their fluid and diet restrictions, and enjoy a much better quality of life. Please also consider socio economic factors and consult Nephrologist and Transplant coordinator.

The blood type of the kidney recipient and the person giving the kidney—the donor—must be compatible, just as they must be for a blood transfusion. There are four blood types: A, B, AB, and O. Note: Rh (the negative or positive element of blood type) has no effect on compatibility.

Recipient Blood Type Donor Blood Type

Type O

Type O

Type A

Type A or O

Type AB

Type B or O

Type B

Type O, A, B, AB
There are two sources for kidney transplants. One is from a close blood relative, and the other is from a non-close blood relative. A living donor (close blood relative/ non- close blood relative) must be in good health and free from diabetes, high blood pressure, cancer, kidney or heart disease. Living donors usually are between 18 and 60 years old. The living donor must undergo a series of tests to determine if they are truly compatible with the recipient. The decision to become a living donor is completely voluntary, and the donor can change his or her mind at any time. Living donors sometimes feel pressure from their families or guilty if they are reluctant to go through with the procedure. They also may feel angry if the recipient’s body rejects the donated organ. Living donors should discuss their feelings with a transplant professional before making a final decision. Typically, the donor is admitted to the hospital the day before the kidney donation for all the necessary tests.
Usually, a perfect match is from a brother or sister, mother, father. The chance of getting a perfect match from a living-related brother or sister is much higher than from non-close blood relative.
During surgery, the kidney is placed in the lower abdomen, either on the right or left side. It is connected to the blood vessels that supply blood to and from the leg. In general, your kidneys are left in place, unless they are have become much enlarged from a condition like polycystic kidney disease, or become a source of infection. Pre-operative tests give a suitable idea to transplant team before the surgery is undertaken.
You will be in the hospital for 8-10 days. You may need to stay longer if a problem occurs and further treatment is needed; however, most people can go home without difficulty.
Because many things can affect the wait time, it is best to check with your transplant coordinator. Patients who can identify a suitable donor (close blood relative/ non-close blood relative)
Stay as fit as possible Go to all your routine health care visits, including dental checkups, flu shots, ECGs, stress testing, colorectal exams, mammograms and pap smears for women, and prostate exams for men. If you have a blood transfusion while on the transplant waiting list, let your transplant coordinator know immediately. While on the list you will need to submit monthly blood samples. If you are on Hemodialysis, your dialysis center can do this for you. If you are not on dialysis we will help you arrange to have this done. Let your transplant center know if you change your address or phone number Let your transplant center know if you have any change in your health status Finally, you should enjoy your life, family and friends.
Each end-stage renal disease patient is assigned a coordinator from the AINUT Kidney Transplant Program at the time of the initial evaluation. Transplant coordinators will be responsible for the overall coordination of your transplant-related care at Aadil Hospital. The coordinator, the transplant team and the physicians will maintain contact with you. At the time of the evaluation appointment, the Transplant coordinators may request the following information from the referring doctor: Full chemistry panel Complete blood count (CBC), differential, platelet count Hepatitis profile HIV screening Blood test for syphilis (VDRL) CMV titers, herpes simplex titers, EBV titers Urine culture with sensitivities Recent electrocardiogram (within 6 months) Chest x-ray Pap smears for women candidates Mammogram for women candidates PSA blood test for male candidates over age 50, to screen for prostate cancer Additional tests that may be requested include: Renal ultrasound Liver ultrasound/gall bladder ultrasound Cardiac studies
An evaluation appointment can be scheduled by calling the Aadil Hospital at 111-22344. During the evaluation appointment, you will meet with the transplant Nephrologist, Anesthetist, neurologist, Cardiologist, surgeon, and transplant coordinator. A member of the transplant team will perform a complete history and physical, review previous test results and decide if any further tests are required. A team member will determine whether you are a candidate for surgery and address any issues that may affect the surgery itself. The transplant team will communicate with you, keep records up-to-date. Information about the transplant evaluation will be provided by the transplant coordinator. An assessment of your emotional well-being, transportation, housing and financial resources will be made by the transplant coordinator/ social worker with involvement by the financial counselor, if necessary. Also during this appointment, blood for tissue typing will be drawn. All other tests, including blood tests, will be arranged according to your provider policy. Potential kidney donors (family members) are encouraged to attend this appointment for information and to initiate the donation process. Tests and examinations that will be performed include: Transplant medical and surgical evaluation Psychosocial evaluation Blood typing Tissue type identification and antibody screening Tissue type identification, blood type identification, and cross match test of any potential donor Following the evaluation appointment, each patient's case is presented at the weekly meeting of the Transplant Evaluation Committee. At this time, a determination is made if any other tests are required to ensure the patient's candidacy for transplant. Your coordinator at AINUT will notify you and your referring physician and/or Nephrologist of the recommendation made by the transplant team. Upon completion of additional tests with satisfactory results.
The Pediatric and Adult Kidney Transplant Programs at AINUT offer living donor (close blood relative/ non-close blood relative) transplantation services. If a patient is accepted as a transplant candidate at AINUT, the possibility of a living-donor transplant is explored and encouraged. With a living donor (close blood relative/ non-close blood relative), a transplant can take place as soon as all tests are completed for the donor and recipient. Unfortunately cadaveric donor program remains underdeveloped in Pakistan.
While you are waiting for transplantation, make plans for what your needs will be following surgery. Transportation to clinic visits, assistance at home, and financial issues are the most common concerns. The transplant coordinator /social worker have a wealth of information and can share previous patient’s experiences. In addition, keeping active, maintaining good nutrition, and stopping smoking are all important factors to keeping as healthy as you can. Most importantly maintain a positive frame of mind.
Punjab Human Organ Transplant Authority governs the rules & regulations pertaining to Human Organs & Tissues The Donor is donating organ on humanitarian grounds. Donor & Recipient should be genetically or legally related. Should qualify as close blood relative i.e. a. Parent b. Son c. Daughter d. Sister e. Brother The donor should be voluntary, genuinely motivated without duress or coercion. In case of non availability of CLOSE BLOOD RELATIVE the Hospital Evaluation Committee may allow donations by NON-CLOSE BLOOD RELATIVE after satisfying itself that such donation is voluntary. This has to be approved by PHOTA before transplant surgery is scheduled. Generally, donors should be between the ages of 18 and 65 years old. You should not have any major medical or psychiatric illness and you must not be pregnant. You should not be overweight, although one may still be a potential donor if one loses weight. If one smokes has to quit for six weeks prior to surgery. Donor also must understand the risks of this surgery and comply with instructions for follow-up medical care.
Yes, it's necessary to be related to the recipient. The relationship between donor and recipient also doesn't appear to affect the amount of anti-rejection medication the recipient needs after transplant. Donor has to be close blood relative or non-close blood relative to be approved by HOTA.
Know your blood type. You must be either the same blood type as the recipient or blood type "O." Your Rh factor — positive (+) or negative (-) — does not affect your ability to donate. Donors family history, may require information, such as smoking, alcohol or drug history are important elements in addition to detailed testing.
We will need blood and urine test results, a chest X-ray and an electrocardiogram (ECG). If these tests suggest that one to be a suitable donor, an intravenous pyelogram and renal arteriogram will be performed to ensure you have two healthy kidneys. A pyelogram is an image of the ureter and renal pelvis made by introducing a radioactive material intravenously. An X-ray image made while the material is excreted provides important information. An arteriogram is a similar image made of the renal arteries. Other tests may be necessary. The purpose of the evaluation is to make sure Donor’s kidneys are normal and that donor doesn’t have any medical or psychiatric illness that would make this procedure risky or difficult. We want to make sure donor doesn’t have any medical conditions that could be transmitted to the recipient and to confirm that donating voluntarily, without pressure.
Bring only minimal belongings and no valuables. Bring documentation with you about your health status, family history. Where will the tests be performed? Generally tests are performed at AINUT. Some tests are performed elsewhere but we insist that the crucial tests are done here. All tests can be verified and patients are encouraged to seek second opinion on this case.
If carrying a medical insurance patient shouldn’t incur any medical expenses related to the evaluation, surgery, hospitalization or immediate post-operative care. These charges are billed to the recipient’s insurance. Aadil Hospital works with most Insurance companies on prior approval basis. Your Transplant Coordinator will guide you more on this.
Aadil Hospital strictly adheres to Patient Rights & Education clause of Punjab Health Care Commission. It is important that you feel completely comfortable disclosing all requested information. Anything discussed in the course of the patient/donor evaluation is between them and the transplant team will be treated as confidential (close blood relative/ non-close blood relative.
Generally, potential donor knows within two weeks of completing the evaluation. Further tests may delay your clearance. It’s important that potential donor allow himself time to digest the information one is reading here and the additional information if required. The decision to donate your kidney is not one to make lightly. Consider it carefully and discuss it with family and significant others.
Donors need to be between the ages of 18 and early 70s and can include parents, children, siblings, other relatives, and friends. An ideal donor should have a genuine interest in donating and a compatible blood type with the recipient. Donors should be in good general health. Donors do not need to be genetically related. Typically, someone who has cancer, diabetes, kidney disease, heart disease, liver disease, sickle cell disease, HIV or hepatitis will not qualify to be a donor. However, these diseases are not all absolute contraindications to donation. Every donor will be considered on an individual basis.
Once PHOTA (Punjab Human Organs Transplant Authority) has approved the case in addition to Hospital’s Evaluation Committee. The data can be decided jointly by the transplant team, donor and the recipient. The transplant team- particularly the doctors involved in the recipient’s care – will determine the best team for the transplant, based on the recipient’s medical condition. Once we know this, we try to accommodate your schedule, if possible. A number of factors could affect our plans. For example, your recipient’s condition might deteriorate so that he or she is too sick for a transplant. Or, the recipient or donor might develop an infection or other condition that must be treated before a transplant.
Antibodies are proteins your immune system makes when it comes into contact with something foreign to your body. When you get an infection, such as a cold or an infection from a wound, your body makes antibodies to fight that infection. Antibodies protect your body. When you have an organ transplant, your body reacts as it would to an infection. Thus, your antibodies try to destroy the organ. Some people have a lot of antibodies, and it is harder to find an organ match.
Kidneys for transplant may come from a person who has died (a deceased donor), or from a healthy living person, like a family member or a friend who offers to donate a kidney (a living donor). Deceased donor program remains under developed in Pakistan. PHOTA is working to formulate guidelines and SOPs for ensuring that such donation is ethical.
Many patients assume they are too old for transplant but if you are otherwise healthy, age is not a factor in determining your transplant eligibility. However, there are some other factors that prevent patients from getting a kidney transplant: Current life expectancy of less than 5 years Recent cancer (other than most skin cancers) Uncorrectable heart disease Untreatable psychiatric illness Missing dialysis appointments or signing off the machine early Active substance abuse (alcohol or drugs) Lack of health insurance or Medicare/Medicaid coverage You and your transplant doctor will discuss your eligibility during the transplant evaluation process.
In general, the sooner you get a kidney transplant, the better. The transplant team and your nephrologists will determine the best time for you. Please consult transplant coordinator for more information.
Anti-rejection medications are taken as long as you have your transplanted kidney. Following transplant, patients usually take: Three types of medication to prevent kidney rejection Decreased doses of medications over time Medications for other health issues (blood pressure, insulin, etc.)
Patients who do not have a living donor should register with AINUT and help us develop recommendations for HOTA for making SOPs and Guidelines for Deceased Donor program Registry regulated by HOTA. AINUT doesn’t support illegal buying and selling of Human Organs. It’s against the law.
Yes. Living donor transplants last longer than deceased donor transplants because a living donor kidney is removed from a healthy donor in the operating room and transplanted right away. Living donor transplants last on average for 15-20 years and deceased donor transplants last for 10-15 years. Some transplants have been known to last much longer. However it also depends upon the Quality of watching and health of patient.
Yes. Patients who have a transplant generally live longer than patients who stay on dialysis. The transplanted kidney works 24 hours a day to remove 50-85% of the total waste your body generates. Dialysis on the other hand only removes 15% of total waste and only when on the dialysis machine.
AINUT performed kidney transplants (2004-2008) are very successful with more than 95 percent of kidney transplants done at Aadil Hospital are still working. We are committed to maintain the same success rate. Living donor transplants last on average for 15-20 years and deceased donor transplants last for 10-15 years provided the patient avoids frequent infections and maintain good health. If a transplant fails, a patient can begin or return to dialysis and/or pursue another transplant. We are committed to maintain the ethical and quality standards.
Most patients say that having a kidney transplant improves the quality of their lives. Patients say that they feel better and have more energy to spend time with their family, do their hobbies, travel and go back to work. Patients also say they have more time, since they do not have to spend hours in treatment with dialysis each week. They are also very satisfied that renal dietary restrictions are removed once they are transplanted.
Each patient is evaluated on a case-by-case basis, but it is uncommon to offer transplantation to patients who are older than 75 years of age.
Each patient is evaluated on a case-by-case basis, but generally we require a body mass index (BMI) of 35 or less.
Yes, we have a pediatric transplant program. Please consult a Pediatric Nephrologist and transplant coordinator at AINUT.
Not necessarily. The transplant surgeons work as a team and a different surgeon may be working on the day you have your transplant.
Consulting with a Transplant Coordinator/ social worker is a critical part of the transplant evaluation process. Meeting with a Transplant Coordinator/ social worker will help you prepare for the impact that a transplant may have on other aspects of your life, and to identify potential resources. Additionally, PHOTA regulations require the transplant center to have a Transplant Coordinator to assess each patient prior to placing a patient undergoing a transplant.
A dietician is involved in care of transplant patients assists with nutritional care prior to transplant to help with weight loss or maintenance, as well as guidelines for preserving kidney function. Post-transplant, patients often experience side effects of medications that benefit from nutritional interventions. Additionally, HOTA regulations require the transplant center to have a dietician assess each patient prior to waitlist placement.
Yes. Kidney patients should try to avoid receiving any blood products (whole blood, plasma, platelets, red blood cells) because this can increase antibody levels in your blood. High levels of antibodies make it difficult to find a tissue matched donor. Transplant coordinators should be notified if a patient takes a blood thinner, such as Coumadin or Plavix, even on a temporary basis. Prior to transplant, patients should consult their local Nephrologist for guidance on medications. There are certain medications that can damage kidney function, such as non-steroidal anti-inflammatory drugs (NSAIDs). Some nephrologists may recommend avoiding these medications prior to starting dialysis, when patients are trying to preserve kidney function. After dialysis is initiated, this may be less of a concern. After receiving a kidney transplant, patients will receive guidance from the transplant team about medications.
When a patient loses 90 to 95 percent of his or her kidney function, they are considered to have End Stage Renal Disease (ESRD). At this point, life-saving treatment becomes necessary. Treatment options for patients with ESRD are dialysis (where an artificial kidney machine removes waste from the blood) or a kidney transplant from a living or deceased donor. Sometimes, a patient with 85 percent loss of kidney function will undergo a transplant which allows them to avoid having to go on dialysis. Kidney patients and their families will discuss the best course of treatment with their doctors.
“Saving a life is saving Humanity” A transplant donor whether close relative or non-close relative is always a VIP at AINUT. The decision to donate can vary from person to person. Some people make the decision instantly with few worries or concerns. Other people require time to think critically and will talk with close friends or family before deciding whether or not to donate. It is normal for some people to be afraid of donating a kidney as well as to experience guilt about not wanting to be a donor. Individuals should not, under any circumstances, feel pressured to donate. The only “right” decision is the one that makes the donor feel comfortable. Potential donors (close relatives or non-close relatives) are encouraged to speak with the Transplant Coordinator and team if they have any questions or concerns about their decision.
If you are interested in being a living donor, you should contact the Transplant Coordinator. Once the questionnaire has been completed it will be reviewed by a nurse coordinator to determine if you may proceed with initial blood testing. Once your blood type, antigen match, and cross match are known, the transplant coordinator will discuss the results and the donation process with you and answer any questions so that you can make an informed decision about proceeding with donation. This conversation is strictly confidential and is not shared with the recipient. If the donor decides to continue with donation, they must then complete a comprehensive evaluation.
Your surgeon and nurse coordinator will discuss all health risks with you. The risks of donation are similar to those involved with any major surgery, such as bleeding and infection. Death resulting from kidney donation is extremely rare. Current research indicates that kidney donation does not change life expectancy or increase a person’s risks of developing kidney disease or other health problems.
Most living donors say they feel great satisfaction with the donation experience because they have helped to improve another person’s quality of life. Even in rare instances where the transplant is not successful, many donors say they feel positive about their decision because they did their very best to help a relative or friend. However, there is a small chance for donors to experience some negative or mixed feelings after the donation. These feelings have been more likely to occur in cases where the outcome of the surgery did not meet the expectations of the donor and/or recipient as well as in cases where the donor was unsure of his or her decision.
A person can lead an active, normal life with only one kidney. Studies have shown that one kidney is sufficient to keep the body healthy. After recovering from surgery, a donor can work, drive, exercise and participate in sports. A donor can continue in all types of occupations. Also, being a donor does not impact a person’s ability to have a child.
Smokers must stop smoking at least one month prior to surgery, all medications and supplements must be reviewed by the transplant team to determine if they need to be held prior to surgery. Women taking birth control pills or hormone replacement therapy are advised to stop taking these medications one month prior to surgery. A few days before the transplant, both you and your recipient will come to the hospital for pre-admission testing. You will meet with an anesthesiologist and a nurse practitioner in the hospital’s PREP Center. You will be provided with specific instructions on how to prepare the night before surgery, such as not eating or drinking anything after midnight. The same day, you will have more lab work completed and will also meet with your nurse coordinator and social worker to review what to expect during your stay in the hospital and at discharge. You will also meet with the social worker earlier in the evaluation process who will help you to consider and prepare for emotional aspects of the donation experience.
Patient & Donor’s family is responsible for their routine annual health maintenance testing (e.g., pap smear, mammogram, colonoscopy, etc.) or medical clearance that may be required for pre-existing conditions. However, all other testing required for the living donor evaluation as well as the hospitalization costs and physician services provided during the donation process are covered either by recipient’s family during their testing and hospitalization checkups. Patient & Donor get a special Healthcare benefits. For deserving suitable candidates AINUT performs transplant surgery on charity basis.
Most of our patients referred by their nephrologists. You can also call us directly to make an appointment for a consultation to discuss your suitability for a transplant with a transplant surgeon, a transplant coordinator/ social worker.
Potential donors include family members (close blood relatives or non-close blood relatives), friends, and others in your community who have heard you need for kidney donation. Potential donor has to be approved by HOTA.
The most important thing to do is make sure your blood pressure is under control by having it measured once a year. Also, it is important to maintain good control of your blood sugar level.
There are some basic things that we monitor for risk of kidney disease: Blood pressure, which should be checked at least once a year Urine analysis, to check protein levels Creatinine level in your blood.
As long as one kidney is healthy, it should not affect a lifespan.
Serum Creatinine is a blood test that your doctor uses to measure how well your kidneys are filtering.
The most important thing to do is measure blood pressure and proteins to ensure that the remaining kidney is still healthy. In most cases, when one kidney goes bad, the other will go bad as well.
There are four major causes of kidney failure, listed from most common to least common include: Diabetes High blood pressure Special kidney diseases known as glomeronephritis Hereditary kidney diseases, such as polycystic kidney disease
It is usually not necessary to remove a kidney that shuts down.
Around 10 percent of kidney failures are caused by hereditary factors.
Fatigue is a common symptom of kidney failure and there are medications that treat this symptom. If the fatigue is too severe, the best way to manage this might be with dialysis.
Kidney infections and certain obstructions can cause back pain. However, most back pain is unrelated to kidney problems.
Many patients with kidney failure have swelling, which is something we can treat with medicine. Another way patients can keep from swelling is avoiding salt in their diets.
There are three advantages to living donations versus getting a deceased donor kidney: There are not enough deceased donor kidneys, so getting a kidney from a friend close blood relative or non-close blood relative is often quicker than waiting on the transplant list for a deceased donor kidney. A kidney from a living donor is completely healthy. They are known to work better and longer than deceased donor kidneys. If the kidney is donated from a relative, the tissue may be a closer match and lower the chance of rejection.
Yes, a kidney from someone who is not a relative can work very well. Provided Punjab Human Organ Transplant Authority approves the case in addition to hospital’s evaluation committee.
Diabetes is now the most common cause of kidney failure in world. About one third of patients with kidney failure have it because of diabetes. There are three main things that can be done to reduce the likelihood of kidney failure in diabetics: Have tight control over blood sugar. Reduce blood pressure, by weight loss or other means. Take blood pressure medicines that are designed to protect against the progression of kidney disease.
Yes. In diabetic patients we monitor both blood pressure and protein in their urine. These tests are done at least once a year.
Kidney stones don’t lead to kidney failure often. However, if they cause long-term obstruction of the kidney, they may lead to kidney failure.
No, generally speaking, patients do not get urinary tract infections because of a non-functioning kidney.
No, excessive alcohol consumption does not cause kidney disease.
Typically it means there is scarring or cysts within the kidney that we see with a special kind of x-ray.
Being overweight is a major contributor to high blood pressure, which often has a relationship with kidney failure. Patients who are seriously overweight should try to get their weight and blood pressure down.
There is no relation between sweets and kidney failure, only sweets and diabetes.
Following a kidney transplant, the length of stay in the hospital is usually eight to ten days, but can extend to several weeks in more complicated cases. You will be seen daily by the transplant team. Discharge planning is started at the time of admission by the coordinator with plans for care at home, transportation to clinic visits, and housing, if necessary. Education about all aspects of after-transplant care including medications, clinic visit schedule and daily activities will be provided by the transplant coordinator.

In recipients, the barely functioning existing kidneys are not removed, as this has been shown to increase the rates of surgical morbidities. However, there are certain indications where in native kidneys are required to be removed prior to transplant. The kidney is usually placed in a location different from the original kidney, often in lower abdomen, the iliac fossa, so it is often necessary to use a different blood supply: The renal artery of the kidney, previously branching from the abdominal aorta in the donor, is often connected to the external iliac or internal iliac artery in the recipient. The renal vein of the new kidney, previously draining to the inferior vena cava in the donor, is often connected to the external iliac vein in the recipient.

When this is complete, blood will be allowed to flow through the kidney again. The final step is connecting the urine pipe (ureter) from the donor kidney to the bladder. In most cases, the kidney will soon start producing urine. Depending on its quality, the new kidney usually begins functioning immediately. Living donor kidneys normally require 3–5 days to reach normal functioning levels, while cadaveric donations stretch that interval to 7–15 days. Hospital stay is typically for 8-10 days Immunosuppressant drugs are used to suppress the immune system from rejecting the donor kidney. These medicines are usually started 1-2 days prior to transplant and must be taken for the rest of the recipient's life. The most common medication regimen today is a mixture of tacrolimus, mycophenolate, and prednisone. Some strong immune-suppressive injections are given during and immediately after surgery. These injections have been shown to result in decrease in acute rejection episodes and better graft survival. Kidney transplantation is a life-extending procedure. The typical patient will live 10 to 15 years longer with a kidney transplant than if kept on dialysis. People generally have more energy, a less restricted diet, and fewer complications with a kidney transplant than if they stay on conventional dialysis. Acute rejection occurs in 10–25% of people after transplant during the first 60 days. Rejection does not necessarily mean loss of the organ, but it may necessitate additional treatment and medication adjustments.

Temperature >100.5F Chest pain, shortness of breath, rapid heart beat Signs of infection (redness, swelling, increase pain, pus) Nausea and vomiting and unable to keep medicines down Draining wound Easy Bruising Increased pain despite pain medications Blood in your stool or urine Rapid weight loss or gain Black tarry stools Leg or calf swelling, tenderness or redness Sudden weakness or numbness on one side of the body or the face Sudden change in vision Difficulty talking Sudden severe headache
Shortly before going into surgery, medicine is given to the patients to help them relax. A general anesthetic is then given. The donor and recipient are in adjacent operating rooms. The transplant surgeon removes the kidney from the donor and prepares it for transplant into the recipient. There, the surgeon connects the renal artery and vein of the new kidney to the recipient’s artery and vein. This creates blood flow through the kidney, which makes urine. The ureter, or tube coming down from the donor kidney, is sewn into the bladder. Usually, the new kidney will start working right away. Sometimes, it takes several days for the donor kidney to “wake up.”
Death from surgery: less than 1 percent, same as any major surgery; surgical complications: infection, fever, bleeding, blood clots; kidney failing in first year (5-10 Percent ). Most transplanted kidneys start working immediately, but some start working slowly and you may need dialysis for one to three weeks after surgery. Internationally, 1 – 2 percent of transplants fail immediately, and 25 percent of patients on average in the nation require dialysis after surgery. These are internationally recognized failure rates. Please consult transplant coordinator for more information specific to your case.
You will be admitted to the hospital the morning of the surgery. Both you and your recipient go directly to the Same Day Surgery Suite at the AINUT. Once there, the staff starts an intravenous (IV) line where fluids are administered. You will meet with your surgeon who will answer any remaining questions and will have you complete a consent form for the procedure. A patient escort will wheel you to the operating room when it is time for surgery. Shortly after arriving in the operating room, the anesthesiologist will give you sedation medicine through the IV. Once you are fast asleep, a breathing tube for general anesthesia is placed which connects to a breathing machine. This routine process assists patients with breathing during surgery. A urinary catheter is inserted into the bladder and then the laparoscopic surgery begins.
When you return home, your activities will be limited. You should not lift anything that weighs more than 20 lbs for the first four weeks. You may feel tired for the first week or two after the surgery and may need frequent naps. However, donors are encouraged to be active in between their periods of rest. Walking is considered excellent exercise during this time. You may also have some swelling around the incision area and should plan to wear loose, comfortable clothes. You will likely be able to return to work 2-3 weeks after the surgery, depending on the type of work. However some donors require a longer recovery period if their work requires heavy lifting or other physical demands.
The operation is different depending on whether it is an “open” surgery or by “laparoscopy.” Both start with an incision made in the person’s side, the blood vessels to the kidney get tied off, and the ureter (the tube from the kidney to the bladder) is tied off and the kidney is taken out. Typically donors recover from laparoscopic surgery within a week and from the open surgery within a couple of weeks.
After a transplant, medications will always be needed to stop the body from rejecting the kidney. These drugs are called immunosuppressant. Because the body can reject the kidney at any time, the medications must be taken every day, for as long as the kidney works.
In the first month after the transplant you will return to the hospital twice a week for laboratory tests and a doctor checkup. The second month after your transplant you will come back once a week. You'll come in every month until the sixth month, and then come in once a year. For the rest of your life, you will need to get monthly lab tests done, in order to monitor your medications and check for any potential problems.
Life of transplanted kidney depends upon (a) Quality of Match (b) Co operation of patients to adjust life style change. On average, a transplanted kidney from a cadaveric (deceased) donor lasts 5-10 years. Some transplanted kidneys only last a few weeks, while others function normally for 10-15 years or more. In general, kidneys from living donors last longer than those from cadaveric donors. The key to extending the life of your kidney is taking your medications as prescribed.
Avoid lifting heavy objects and strenuous physical work for at least six to eight weeks following surgery. It is important that you also do not lift anything heavier than 20 pounds for two to three months, and nothing heavier than 40 pounds for four to six months from the date of your surgery. Avoid driving for at least six weeks following surgery. Plan ahead so a friend or family member can help out during this time. When you are in a moving vehicle, always use your seat belt. Exercise is encouraged, and we recommend beginning with stretching exercises and walking. Other excellent exercises include jogging, hiking, bicycling, tennis, golf, swimming, and aerobics. All of these can help you regain your strength and may be started gradually after your incision has healed. As a general rule, rough contact sports should be avoided since they might cause injury to your transplanted kidney. If you have doubts about any activity, please ask the Transplant Team. When will I be able to return to work? Many kidney transplant patients are able to return to work within a few months following a successful surgery. However, various aspects of the recovery process can affect the timing of your return. You will need to discuss returning to your job with the Transplant Team.
Always take all of your medicine with you and make sure you have enough medicine to last throughout month. Always get your post op labs done on time. Fluctuatory Cyclosporine levels may require adjustment of medicines after consultation with Nephrologist. Will there be any problems with my sexuality after the surgery? While a kidney transplant can cause many life changes, it does not affect a woman's desire to become pregnant or hinder a man's ability to father a child. Recommendations for female transplant patients Although fertility is not a problem, rejection or high blood pressure is both complications a woman might experience for at least one year following transplant surgery. It is important to prevent a pregnancy during this time by taking extra precautions. This doesn't mean that you cannot have a healthy pregnancy later. However, you should know the risks and make sure your doctor has experience dealing with a transplant patient. It is also important to know that a transplant patient who becomes a new mother should not breastfeed her baby. The immunosuppressive medicine prescribed after transplantation can be passed through the mother's breast milk and can cause harm to the baby. Female transplant patients should be sure to have a yearly PAP test (a test for cancer of the cervix) and a mammogram. Immunosuppressive medicine could cause increased susceptibility to various types of cancer. Pap tests and mammograms are preventive measures that can help your health care providers detect any problems. Recommendations for male transplant patients Male transplant patients might experience difficulty with erections of the penis after surgery. This might be caused by a reduction of blood flow to the penis, or it might be a result of the transplant medicine. In most cases, this situation can be corrected.
Follow-up Visits For the first 3-4 months after the transplant patient will be seen in clinic once or twice a week, and return to the lab for blood tests more frequently and possibly be temporarily readmitted (this can happen in up to 50% of patients in the first 6 months). It is patient’s responsibility to ensure that you can get back and forth from the hospital when needed. It is very important to let all of your other doctors and your dentist knows that you have had a kidney transplant. Monitoring Your Kidney It is important to check your blood pressure, and follow your fluid intake and urine output and weight. We encourage kidney transplant recipients to take an active role in monitoring their kidney function. Diet It is important to make sure you drink enough fluids after you leave the hospital. 3.5 – 4 L per day is appropriate. It is normal to have a slightly decreased appetite after major surgery. Take it easy and eat what feels right. If your kidney function is normal, you have no dietary restrictions. Avoid alcohol Excessive alcohol drinking can lead to liver problems and dehydration that can hurt your transplanted kidney. Do NOT smoke Smoking can shorten your life and the life of your transplanted kidney. Weight Gain Weight gain is common after kidney transplantation because, aside from the fact that patient may feel better, and food will taste better, your anti-rejection drugs may increase patient’s appetite. Always ask to see a dietician if patient at all in doubt about how and what you should be eating. The key to avoiding weight gain is watching what patient eat, and exercising regularly. It is also important to adopt healthy eating habits, and avoid nibbling in front of the television, or eating out of habit.
Drink plenty of water: We often mistake thirst for hunger. Drink a full cup of water before meals. It makes you feel more full and is good for the kidney. Eat 3 regular meals: Have a larger breakfast and smaller lunch and dinner Eat slowly: To allow brain to register that you are full! Spend 20-30 minutes on each meal Choose a regular place to eat and sit down Have 1-2 small snacks in the mid morning and afternoon: Examples of healthy snacks: Fruit; Salads; Unsalted nuts; Curd
If you eat the right food, you don’t have to feel hungry. Choose carbohydrates that are less refined. Unrefined carbohydrates come from plant foods in their natural form, for example, fruits, vegetables, grains, and beans. Whole grain and cereals are good sources of unrefined carbohydrates. These foods are filling and take a longer time to digest. As a rule, fresh fruit and vegetables are very healthy. Eat at least 5 servings/day. It is better to eat fresh fruit than to drink juice, because it contains fiber. Remember that potassium restriction is not required with a functioning kidney. You can now eat bananas! Sugary foods can cause high blood Sugar. Eating sugary foods (sugar, candy, soft drinks, honey, jelly) and refined carbohydrates (Pizza, white bread, white rice) makes your pancreas work hard to produce insulin. All transplant patients have a tendency to develop diabetes (because diabetes is a possible side effect of immunosuppressive medications). Don’t make meat, poultry or fish the main dish Eat meat products in moderation, and make vegetable dishes Trim all fat from meat and remove skin from chicken. However, we do encourage you to have 1-2 servings of fish per week Keep your salt intake low if you have high blood pressure or fluid retention (swollen ankles)

After a few days in hospital, most people feel more tired than they expect to when they get home. Many times, whether or not you are up to a particular activity will depend upon whether or not you are back to a regular well balanced diet and good sleep pattern. Once you are at home, start out by doing just those activities you know you could do while in hospital. Think about adding one new activity at a time and make sure you are well rested when you begin. Plan on taking pain medicine, if needed, half an hour before trying a new activity. Avoid doing exercises that strain your abdominal incision (e.g. Crunches, heavy lifting) until checking with your doctor. Start by spending 10-15 minutes on the new activity to see how you feel. Begin slowly and pace yourself. If you feel tired, you can slow down or stop and plan to try a little later. Doing a little at a time will help you to build your strength and endurance. Frequent rest periods will help you to stay active during recovery from any illness. If you feel short of breath or have chest pain, you should check with your doctor immediately. The following includes common daily activities listed by how much work or energy they require. Activities at the top take the least energy. These recommendations are based on our general collective experience and common sense. We encourage you to discuss each item below with your nurses and doctors to get the most appropriate information specific for you.

Activity When to Resume

Walking/Exercising

 Check with your doctor before doing strenuous exercise like jogging, aerobics, weightlifting and tennis. 

Avoid exercise if you experience pain in your joints, have chest pain, have a fever or you are a diabetic and your glucose is over 300 or less than 70 mg/dL.  Talk to your doctor about these things.

Drink plenty of fluids when exercising.
Travel

After discussion with your doctors.
Before you travel, check with your transplant team – certain destinations will require special precautions such as: vaccinations or antibiotics.
Locate the nearest transplant center at your destination, BEFORE you travel.

Take along enough of your medications for your entire trip (include extra doses just in case) and keep them with you at all times (NOT in checked baggage).

Back to Work

After discussion with your doctors.

Taking a Shower

 Immediately, but allow the water to run over your incision. Avoid having the water hit it directly. Dry the incision completely by gently patting instead of rubbing.
Sexual Activity When you feel comfortable or as instructed by your doctor.  There is no reason why you should refrain from sexual activity unless you or your partner is sick or has a vaginal infection.  If either you or your partner has an infection, both of you should seek treatment prior to intercourse.
Driving Not until you have stopped taking pain medication.
Lifting With an abdominal incision, avoid lifting more than 5 kg (about the weight of a bag of groceries) for 6 weeks to allow your inner tissues and muscles time to regain their usual strength.

No. If the transplant doesn’t work, you can:

Start or resume dialysis

Pursue another transplant

Your health status may change with time so it is important for you to have a re-evaluation. This helps to keep track of medical changes and to ensure that you are always ready for transplantation and do not miss an opportunity.
You will have a post-operative appointment with your surgeon 1-2 weeks after the surgery. Additional follow-up appointments will be scheduled 6 months, 1 year and 2 years after your donation. This will allow our team to monitor your kidney function. After your 2 year follow-up with the transplant center, we recommend annual checkups.