What is Living Donor Kidney Transplant? Purpose, Procedure & Results

A living donor kidney transplant is a surgical procedure where a healthy person donates one of their kidneys to someone whose kidneys have failed or are failing. This life-saving treatment offers the best chance for long-term success compared to other kidney replacement options.

Unlike waiting for a kidney from someone who has died, living donation allows the transplant to happen when both you and your donor are in the best possible health. Your body can function perfectly well with just one healthy kidney, which makes this remarkable gift of life possible.

What is a living donor kidney transplant?

A living donor kidney transplant involves removing a healthy kidney from a living person and placing it into someone with kidney failure. The donated kidney takes over the job of filtering waste and excess fluid from your blood.

This type of transplant can come from family members, friends, or even generous strangers who want to help. The donor undergoes extensive medical and psychological evaluation to ensure they're healthy enough to donate safely. Meanwhile, you'll also go through comprehensive testing to make sure you're ready to receive the new kidney.

The beautiful thing about kidney donation is that people are born with two kidneys but only need one to live a completely normal, healthy life. The remaining kidney grows slightly larger to handle the extra workload, and donors typically experience no long-term health problems.

Why is living donor kidney transplant done?

Living donor kidney transplant is recommended when your kidneys can no longer filter waste and toxins from your blood effectively. This procedure offers you the best chance at returning to a normal, active life without the limitations of dialysis.

Your doctor might suggest this option if you have end-stage kidney disease caused by conditions like diabetes, high blood pressure, polycystic kidney disease, or autoimmune disorders. These conditions gradually damage your kidneys until they work at less than 10-15% of their normal capacity.

The main advantage of living donation is timing. Instead of waiting months or years on a transplant list, you can schedule the surgery when you're still relatively healthy. Research shows that people who receive living donor kidneys tend to have better outcomes and longer-lasting transplants compared to those who receive kidneys from deceased donors.

What is the procedure for living donor kidney transplant?

The living donor kidney transplant involves two separate but coordinated surgeries happening at the same time. Your donor's surgery focuses on safely removing one healthy kidney, while your surgery involves placing that kidney into your body.

For your donor, the procedure typically takes 2-3 hours and is often done using minimally invasive techniques. The surgeon makes several small incisions in the donor's abdomen and uses a tiny camera to guide the removal of the kidney. This approach leads to faster recovery and less scarring compared to traditional open surgery.

Your surgery takes about 3-4 hours and involves placing the new kidney in your lower abdomen, usually on the right side. Surprisingly, your own kidneys are typically left in place unless they're causing complications. The new kidney is connected to nearby blood vessels and your bladder, and it often starts producing urine right away.

Both surgeries happen in the same hospital, often in adjacent operating rooms. This coordination ensures the kidney spends the least amount of time outside the body, which helps preserve its function. You'll both be monitored closely in the recovery area before being moved to your hospital rooms.

How to prepare for your living donor kidney transplant?

Preparing for your living donor kidney transplant involves several months of medical evaluations, lifestyle adjustments, and emotional preparation. This comprehensive process ensures you're in the best possible condition for surgery and recovery.

Your medical team will run extensive tests to evaluate your heart, lungs, liver, and overall health. These might include blood work, imaging scans, heart function tests, and cancer screenings. You'll also meet with a transplant psychologist to discuss the emotional aspects of receiving this life-changing gift.

Here are the key steps you'll need to take before your transplant:

• Complete all required medical tests and appointments
• Update your vaccinations, as some vaccines can't be given after transplant
• Attend transplant education classes to learn about post-surgery care
• Arrange for support at home during your recovery period
• Stop smoking and limit alcohol consumption if applicable
• Maintain good nutrition and exercise as approved by your team
• Prepare your home for recovery with necessary supplies and modifications

Your donor will go through a similar evaluation process to ensure they're healthy enough to donate safely. This includes psychological counseling to make sure their decision is voluntary and well-informed.

How to read your living donor kidney transplant results?

After your living donor kidney transplant, your medical team will monitor several key indicators to assess how well your new kidney is functioning. The most important measure is your serum creatinine level, which shows how effectively your kidney is filtering waste from your blood.

Normal creatinine levels after transplant typically range from 1.0 to 1.5 mg/dL, though this can vary based on your size, age, and muscle mass. Your doctor will establish your baseline level in the weeks following surgery, and any significant increases might indicate your kidney isn't working as well as it should.

Other important tests include your blood urea nitrogen (BUN), which measures another waste product, and your estimated glomerular filtration rate (eGFR), which estimates how much blood your kidney filters per minute. You'll also have regular urine tests to check for protein or blood, which could signal complications.

Your medication levels will be monitored closely, especially your immunosuppressive drugs that prevent rejection. These medications need to be kept within specific ranges to protect your new kidney while minimizing side effects.

How to maintain your kidney transplant health?

Maintaining your transplanted kidney's health requires a lifelong commitment to taking medications, attending regular check-ups, and making healthy lifestyle choices. The good news is that most people find these routines become second nature over time.

Your most important job is taking your immunosuppressive medications exactly as prescribed, every single day. These drugs prevent your immune system from attacking your new kidney, but they must be taken consistently to work effectively. Never skip doses or stop taking them without your doctor's approval.

Regular monitoring appointments are crucial, especially in the first year after transplant. Initially, you might visit your transplant team twice a week, but this gradually decreases to monthly, then every few months as your kidney stabilizes. These visits include blood tests, physical exams, and medication adjustments.

Here are essential steps to protect your transplanted kidney:

• Take all medications exactly as prescribed, at the same times each day
• Keep all scheduled follow-up appointments
• Maintain a healthy diet with appropriate portions and limited sodium
• Stay physically active with your doctor's approval
• Protect yourself from infections through good hygiene and avoiding crowds when sick
• Wear sunscreen and protective clothing due to increased cancer risk
• Avoid contact with people who have contagious illnesses
• Report any symptoms or concerns to your transplant team immediately

Your transplant team will provide detailed guidelines about which foods to avoid, how to prevent infections, and when to seek medical attention. Following these recommendations helps ensure your new kidney continues working well for many years.

What are the risk factors for kidney transplant complications?

Several factors can increase your risk of complications after a living donor kidney transplant. Understanding these risks helps you and your medical team take steps to minimize them and catch any problems early.

Age plays a role, as older recipients may have a higher risk of complications and slower healing. However, age alone doesn't disqualify you from transplant if you're otherwise healthy. Your overall health status, including conditions like diabetes, heart disease, or previous surgeries, also influences your risk level.

The most significant risk factors include:

• Diabetes or poor blood sugar control
• Heart disease or high blood pressure
• Previous organ transplants or multiple surgeries
• Obesity or significant weight issues
• History of cancer or certain infections
• Smoking or substance abuse
• Poor social support or inability to follow medical instructions
• Certain genetic factors that affect drug metabolism

Your transplant team carefully evaluates these factors during your evaluation process. Many risk factors can be improved before transplant through lifestyle changes, better medical management, or additional treatments.

What are the possible complications of living donor kidney transplant?

While living donor kidney transplants are generally very successful, it's important to understand the potential complications that can occur. Most complications are manageable when caught early, which is why regular monitoring is so crucial.

The most serious concern is kidney rejection, where your immune system attacks the transplanted kidney. This can happen even years after transplant, which is why you'll need to take immunosuppressive medications for life. Acute rejection can often be treated successfully if detected early through regular blood tests.

Here are the main complications to be aware of:

• Kidney rejection (acute or chronic)
• Increased risk of infections due to immunosuppressive medications
• Higher chance of developing certain cancers, especially skin cancer
• Cardiovascular problems including high blood pressure and heart disease
• Bone disease and increased fracture risk
• Medication side effects including kidney toxicity
• Surgical complications like bleeding, blood clots, or wound healing problems
• Diabetes or worsening of existing diabetes

Less common but serious complications include severe infections, certain types of lymphoma, and problems with the blood vessels connected to your new kidney. Your transplant team monitors for all these possibilities through regular testing and examinations.

The good news is that most people who receive living donor kidneys do very well long-term. With proper care and monitoring, many transplanted kidneys function well for 15-20 years or more.

When should I see a doctor after kidney transplant?

You should contact your transplant team immediately if you experience any concerning symptoms after your kidney transplant. Early detection and treatment of problems can often prevent serious complications and protect your new kidney.

Fever is one of the most important warning signs to watch for. Any temperature above 100.4°F (38°C) could indicate an infection, which can be particularly dangerous when you're taking immunosuppressive medications. Don't wait to see if it goes away on its own.

Contact your transplant team right away if you experience:

• Fever above 100.4°F (38°C)
• Flu-like symptoms including chills, body aches, or fatigue
• Decreased urine output or changes in urine color
• Swelling in your legs, ankles, or around your eyes
• Sudden weight gain (more than 2-3 pounds in a day)
• Pain or tenderness over your transplanted kidney
• Nausea, vomiting, or inability to keep medications down
• Shortness of breath or chest pain
• Severe headaches or changes in vision
• Any new lumps, bumps, or skin changes

You should also reach out if you have questions about your medications, miss doses, or experience side effects. Your transplant team is there to support you, and they'd rather hear from you about small concerns than deal with bigger problems later.