Kidney Transplant

Your kidneys, a pair of reddish-brown organs located on either side of the spine below the diaphragm, filter your blood and remove excess fluid your body. The lives of those suffering from end-stage renal disease (ESRD) can be saved through a kidney transplant.

More kidneys are transplanted in the U.S. every year than any other organ, and as more and more people are diagnosed with ESRD, the number of people requiring kidney transplants continues to grow. At the same time, more lives than ever are being saved through the generous “gift of life” from living kidney donors.

Memorial Hermann's first kidney transplant was performed in 1977. Since then, more than 2,600 kidney transplants have been performed at the Transplant Institute at Memorial Hermann-Texas Medical Center (“Transplant Institute”), which is ranked as one of the top 50 hospitals in the nation for kidney disorders by U.S. News & World Report.

The multidisciplinary kidney transplant team at the Transplant Institute is comprised of specialty trained transplant nephrologists, transplant surgeons, transplant nurses, transplant anesthesiologists, transplant coordinators, financial counselors, social workers and dietitians.

Through our partnership with the McGovern Medical School, the Transplant Institute remains at the forefront of disease management for kidney disorders, immunosuppression research and surgical advances.

Dialysis is the mechanical removal of wastes and excess fluid from the body when the kidneys are not able to perform this function. There are two primary types of dialysis for patients affected by ESRD:

• Hemodialysis - In hemodialysis, the patient is connected through an intravenous (IV) tube to an external device, called a dialyser, which filters the blood and removes excess fluid and waste. The filtered blood is then returned to the body through the IV tube. Patients undergoing hemodialysis receive treatment at a dialysis center or, in some cases, at home, typically three times per week, for several hours.
• Peritoneal dialysis - Peritoneal dialysis uses the peritoneal membrane, which lines the abdominal cavity, to filter waste and excess fluid from the body. The process begins by placing a catheter in the abdomen, which allows the cleansing fluid (dialysate) to enter the patient and flush the waste and fluid. Once trained on the treatment process, peritoneal dialysis is typically performed by the patient at home, often at night, during sleep.

While dialysis may provide temporary relief for patients with ESRD, the survival rate and quality of life for these patients dramatically increases with transplant versus long-term dialysis.

Life-saving kidney transplantation is made possible through the generous “gifts of life” by donors, either living or deceased.

Living Donor Donation

Living kidney donation, meaning a living person donates one of his or her kidneys, is usually the fastest and most effective way for a person with end-stage kidney disease to receive a kidney transplant. Living donors are volunteers and are sometimes, but not always, members of the recipient's family.

The recipient and potential donor will be checked for blood-type compatibility. If the two are not a match, there is still an opportunity for donation through the Paired Donation system, which allows potential kidney recipients to “swap” kidneys with a different donor who is a blood type match.

The surgery is generally safe for both donor and recipient. Donor operations are conducted laparoscopically by two experienced surgeons working together to ensure the donor's safety. Laparoscopic surgery allows for minimal scarring and significantly reduced pain compared to conventional open surgery. Most living donors are ready to leave the hospital two days after surgery and many return to work within weeks of their procedure.

Start the process here to learn more about living kidney donation.

Deceased Donor Donation

Most donors registered to become donors (upon their deaths) when they signed up for or renewed their driver’s licenses. Others registered through the DonateLifeTexas.org registry. Even if a deceased person did not register but is a candidate for donation, his or her next-of-kin can provide consent for donation on his or her behalf.

Upon a donor’s death, the donor’s organs and/or tissues are recovered by an organ procurement organization (OPO). The OPO serving Northern and Southeastern Texas, including the Houston area, is LifeGift. To learn more about the organ donation process (for donation from deceased donors), please visit the LifeGift website.

A kidney transplant may involve one or both kidneys, if the donor is deceased, and only one kidney if the donor is living. In most transplants, only one kidney is transplanted. In certain circumstances, particularly if the donor is less than ideal, two kidneys may be transplanted.

Kidney Transplant Evaluation

Once an individual decides to consider kidney transplantation (becoming a kidney recipient), an initial evaluation is made to ensure that kidney transplantation is the right option for the patient.

Once the patient has chosen the path of transplantation for treatment, the patient will receive a thorough evaluation from the kidney transplant team, which includes transplant nephrologists, transplant surgeons, transplant nurses, financial counselors, social workers and dietitians. The overall evaluation takes approximately three days and includes:

• Diagnostic & Blood Testing, including blood tests, x-rays, ultrasounds, CT scans and cardiac testing.
• Appointments to See Other Specialists, such as cardiologists, gynecologists, urologists and gastroenterologists, as necessary, to determine if it is safe to proceed with kidney transplantation.
• Psychosocial Evaluation, to help prepare the patient and loved ones for kidney transplantation. Financial counselors are also available to help make necessary arrangements prior to transplantation.
• Patient Education, to help the patients and their loved ones fully understand the transplant process, a crucial step in successful kidney transplantation.

Once the evaluation is complete and the results of the tests are received, the multidisciplinary transplant team will confirm that kidney transplantation is a safe procedure for the patient and, if so, will place the patient on the kidney transplant national waiting list, administered by The United Network for Organ Sharing (UNOS).

Waiting times vary depending on blood type, and the average wait time at our center is the shortest in Houston and below the national average, per SRTR¹.

Patients awaiting kidney transplantation on our transplant list are seen by affiliated Transplant Institute physicians on an annual basis to ensure that they will be ready for transplantation when the kidney becomes available.

Kidney Transplant Procedure

Living donor transplants will be scheduled on a date chosen ahead of time and will be performed on an elective basis. For deceased donor transplants, this scheduling is not possible, as the transplant must be performed soon after the organ becomes available.

When a deceased donor kidney becomes available, the patient will be notified and will be admitted to the hospital. The patient will meet again with a nephrologist and a transplant surgeon to answer any questions, and the patient (or patient’s legal guardian) will sign a consent form authorizing the procedure.

If the patient has been on dialysis, he or she may require a session of dialysis prior to the transplant procedure. The Transplant Institute provides both hemodialysis and peritoneal dialysis, so it is unnecessary for the recipient to bring his/her peritoneal dialysis supplies. Sometimes, a final matching test (histocompatibility) must be done before the transplant can happen. If the patient and donor do not match, the patient may have to wait for another kidney.

The transplant procedure is the same whether the kidney comes from a living donor or a deceased donor. It is performed under general anesthesia and typically takes about 2-3 hours. The team of specialized transplant anesthesiologists will ensure that our patients receive the best available care while the kidney transplant is being performed. A plastic stent is usually placed inside the ureter and bladder during the procedure and will be removed by an urologist several weeks after the transplant.

Following the procedure, patients are taken directly to a dedicated Transplant Surgery Intensive Care Unit (TSICU) to recover. Most patients spend only one night in this unit before being transferred to the regular transplant surgery floor. Many patients have immediate function of the transplanted kidney and will not require any dialysis after the transplant procedure. The hospital stay following a kidney transplant is typically 3-4 days.

¹ Source: Scientific Registry of Transplant Recipients (SRTR). Cohort: 01/01/2016 - 12/31/2016

Kidney transplantation carries associated risks, including the risk of the body rejecting the implanted kidney(s), the risk of infection and the increased risk of cancer from the immunosuppression (anti-rejection) medication administered to reduce the risk of rejection.

It is important to know that rejection does not usually mean loss of the transplanted organ. Rather, rejection simply means that the balance of the immune system and the organ has changed and immunosuppression needs to be increased. Your doctor will discuss the risks associated with transplantation with you prior to your procedure.

The goal of kidney transplantation is to return patients to a full, satisfying quality of life, free of dialysis and dietary restrictions. Patients typically return to school, work, non-contact sports and other activities they enjoyed prior to developing kidney disease.

Following transplant surgery, the transplant physicians and staff continue to monitor recent kidney recipients very closely. Clinic visits are scheduled weekly or twice-weekly during the early period post-transplant, and the time between visits will increase according to the patient's needs. Patients from outside the Greater Houston area should plan to stay in Houston for 2 to 4 weeks after transplant to ensure that this close follow-up is possible.

Transplantation can sometimes seem overwhelming for patients. The Transplant Institute offers a transplant support group, run by our transplant social workers. The group meets monthly and includes patients who are waiting for a transplant as well as those who have already received a transplant. Adult family members, friends and caregivers are welcome and encouraged to come with the patient.

To learn more about our transplant support group, call (713) 704-5200.