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Surgical Procedures for End-stage Renal Disease (ESRD)

A kidney transplant may be a treatment option for ESRD.

Kidney Transplant

Kidney transplant is an alternative to dialysis in individuals who have severe renal disease. A kidney transplant is a surgical procedure that inserts a healthy kidney from a donor into your body. Your kidney(s) are left in place, unless they are causing problems like an infection or high blood pressure. The donor may be a living relative, a close friend or anonymous donor whose tissue closely matches yours, or someone who has died and donated their organs. One transplanted kidney does the work of both failed kidneys.

In a kidney that fails, rejection of the transplanted kidney occurs within 3 to 4 months after the surgical procedure. The symptoms of rejection include: fever, weight gain, reduced urine output, and an increase in blood pressure. Blood tests will also show deteriorating renal function. Drugs that keep your immune system from rejecting the kidney can keep the transplanted kidney working. There have been major advances in the development of immunosuppressive agents, including the following:

  • Tacrolimus
  • Mycophenolate mofetil
  • Anti-interleukin 2 receptor antibodies
  • Antithymocyte globulin
  • Muromonab-CD3
  • Alemtuzumab
  • Sirolimus

Complications from kidney transplantation and using immunosuppressive drugs include:

  • Surgical complications, such as pain, infection, and scarring
  • Obstruction of the ureter requiring operation
  • Failure of the new kidney to function properly
  • Coronary artery disease
  • Osteoporosis
  • Adverse effects from immunosuppressive drugs:
    • Infection
    • General cancer risk increases 10-15 times, the risk of cancer of the lymphatic system increases 30 times.
    • Diabetes risk increases much more among African Americans than other ethnic group.

Revision Information

  • Andrews PA. Renal transplantation BMJ. 2002;324(7336):530-534.

  • Chronic kidney disease (CKD) in adults. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T115336/Chronic-kidney-disease-CKD-in-adults. Updated August 23, 2016. Accessed October 4, 2016.

  • Davis, CL, Delmonico, FL. Living-donor kidney transplantation: a review of the current practices for the live donor. J Am Soc Nephrol. 2005; 16(7):2098-2110.

  • What I need to know about kidney failure and how it's treated. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/health-information/health-topics/kidney-disease/kidney-failure-choosing-a-treatment-thats-right-for-you/Pages/ez.aspx. Updated September 2013. Accessed November 17, 2016.