|SSM Cardinal Glennon Children's Medical Center|
Kidneys aren't body parts that you think about much — unless you have kidney disease. Kidneys are vital to a person's survival because they filter waste, as well as extra fluid and salt, from the body. If they stop working (known as kidney failure), a person will need to go on kidney dialysis or get a kidney transplant.
What Is a Kidney Transplant?
A kidney transplant is an operation where doctors put a new kidney in the body of someone whose own kidneys no longer work properly. One healthy kidney can do the work of two failed kidneys.
Because people can survive with just one kidney, a living person can give one of his or her healthy kidneys to someone with kidney failure (this is called being a donor). A kidney also can come from a donor who has recently died, but the wait for this kind of donated kidney can often take a year or more.
Most kidney transplants are successful. People who have kidney transplants will take medications for the rest of their lives to prevent the body from rejecting the kidney. But aside from that, many teens who have kidney transplants go on to live normal, healthy lives once they recover from surgery.
How Do Kidneys Work?
Kidneys are bean-shaped organs located near the middle of a person's back, just below the ribs. Most people have one kidney on either side of their backbone. Kidneys help to clean the blood by removing things like excess fluids, salts, and waste products. The fluids and waste are turned into urine and exit the body as we pee.
Kidneys also release hormones that help regulate blood pressure, create new red blood cells, and maintain calcium levels for healthy bones.
If the kidneys stop working properly (kidney failure), it causes harmful waste products and excess fluid to build up in the body. A person's blood pressure also may rise and the body might not make enough red blood cells. If these problems aren't treated, they can quickly become life threatening.
What Causes Kidneys to Fail?
In teens, kidney failure is usually caused by:
Diabetes and high blood pressure are two top reasons for kidney transplants in adults — and both of these conditions are becoming more common in teens. Although it's unlikely that people with these conditions will need kidney transplants during their teens, managing diabetes and high blood pressure now could help teens avoid kidney disease when they become adults.
Treating what's causing a person's kidney damage can sometimes help heal the kidneys. But if the person has lost too much kidney function, doctors will either recommend or a kidney transplant.
For teens who are candidates for transplant surgery, a transplant can be a good option. Since dialysis treatments are usually needed daily or multiple times a week, they can interfere with a person's routine (e.g., missing school). A successful kidney transplant can make it easier for people to live like they did before their kidneys failed.
What Are the Different Types of Kidney Transplants?
There are two kinds of kidney transplants depending on who donates the new kidney.
A living-donor transplant is when a person with kidney failure gets a kidney from someone who is still alive (usually a relative or close friend, but occasionally a stranger).
A non-living-donor transplant is when people donate their kidneys for transplant after they die. This requires people who need kidneys to put their names on a waiting list until a suitable donor can be found.
How Should You Prepare for a Kidney Transplant?
If your doctor thinks you can have a kidney transplant, your first step is to visit a transplant hospital. A health care team there will evaluate you to see if you're healthy enough to have surgery and take the medicines you'll need to use for the rest of your life. The evaluation may include blood tests, X-rays, and other tests, and can take a few weeks.
If the transplant team decides you're a good candidate, the next step is to find a kidney. In some cases, kidneys come from a close relative or friend who has the same type blood and tissue and whose organs are similar in size to the recipient's.
If a living donor can't be found, your name will be added to a waiting list until a suitable kidney from a non-living donor is located. Since there are far more people in need of new kidneys than there are kidneys being donated, this process can take a long time.
If your name is on the waiting list for a kidney transplant, you'll need to stay in close touch with your doctors and the rest of your health care team. Make sure they know how to reach you at all times. When a kidney is located, you'll need to move quickly. Keep a bag packed and be ready to go to the transplant hospital at a moment's notice.
While you wait for a transplant, do your best to stay as healthy as possible. That way, you'll be ready for transplant surgery when the time comes. Eat healthy foods and get regular exercise, take all your medications as directed, and keep all your medical appointments — especially if you are getting dialysis. Let your doctor and the transplant center know right away if there are any changes in your health.
What Happens During a Kidney Transplant?
When you arrive at the hospital for surgery, you will probably give doctors a blood sample so they can do an antibody cross-match test. This is done to find out if your immune system will accept the new kidney. If the test comes back negative, the kidney is acceptable, and the transplant can begin.
In the operating room, the anesthesiologist will give you a general anesthetic so you'll sleep through the operation. The surgeon performing the transplant will then make a small cut in the lower part of your abdomen, just above your hips. The new kidney will be placed in your abdomen, and the surgeon will attach the kidney's blood vessels (artery and vein) to blood vessels in your lower body. Then the new kidney's ureter will be connected to your bladder.
In most cases, your own kidneys will be left in place and won't be removed unless they are causing problems like high blood pressure or an infection. Kidney transplant surgery usually takes about 3 to 4 hours to complete.
What Happens After a Kidney Transplant?
After kidney transplant surgery, you'll spend a few days (or up to a week) in the hospital as you recover. During this time, your health care team will monitor you closely to make sure there are no complications from the surgery, such as bleeding or infection. You'll also learn how to take the medicines you need to keep your body from rejecting the new kidney.
Here's what it means when medical staff talk about the body "rejecting" a kidney: A person's immune system is programmed to sense foreign objects (such as germs) and help the body get rid of them. Unfortunately, your immune system will recognize a new kidney as a foreign object and will attempt to reject it. To keep this from happening, you'll need to take medicines called immunosuppressants.
Immunosuppressants can make you more likely to get infections (especially in the days immediately after surgery). So be sure to stay away from sick people and tell everyone at home to wash their hands frequently.
For the first few weeks after surgery, you'll need to see the doctor a lot to make sure your new kidney is working normally. If you develop a fever or soreness in the area of the transplant, tell a doctor immediately. These could be signs that your body isn't taking to the new kidney. If the new kidney is rejected or fails, you can go on dialysis or possibly have another transplant.
With modern advances in surgical techniques and immunosuppressant medications, the overall success rate of kidney transplants is very high. When the body accepts a transplanted kidney, it typically keeps working for 10 to 20 years. After that, a person will need to look into another transplant or go on kidney dialysis.
What Can I Do After a Kidney Transplant?
There's a good chance you'll get back to doing most of the things you enjoyed before your kidneys failed. You may have to cut back on rough contact sports, though. Sports like football, hockey and wrestling can lead to injuries that could damage the new kidney. If you have questions about whether a sport is a good idea for you, get permission from your doctor before you start playing.
Be sure to ease back into all activities while you are recovering, and don't go too crazy eating foods that are no longer off limits. Eating well, exercising, and taking care of your body will help keep your new kidney healthy.
Dealing With Feelings
Living with a chronic condition like kidney failure can be frustrating sometimes. Things like dialysis, time spent waiting for a donor kidney, surgery, and medications can be overwhelming. After transplant surgery, some people feel depressed or anxious. It can be a lot to deal with!
Immunosuppressant therapy can be especially difficult for teens because it does have some side effects. The medicines you'll take to stop your body rejecting the kidney can cause acne, weight gain, and excess facial and body hair in women. If you notice side effects, talk to your doctor to see if there's anything that can be done.
If it seems like the stress of living with kidney failure or undergoing transplant surgery is more than you can handle, talk to someone. A parent is best, since your mom or dad will probably be going through the whole experience with you. But some teens find help by talking to a therapist or joining a support group.
Often, it can be a huge relief just talking about your feelings with other people who know what you're going through. If this sounds like something you might like to do, talk to your transplant hospital to see if they have (or know of) any support groups for teens who've had kidney transplants.
Reviewed by: Elana Pearl Ben-Joseph, MD