What might go wrong after the transplant?

What might go wrong after the transplant?

As with anyone who has an operation, the person who has had a transplant operation may feel worse initially. It is very common for there to be a ‘hiccup’ in the first days / weeks / months after a transplant, though there are a few people who escape ‘scot-free’ and have no problems. The early complications can be considered as those common to any operation and those specific to having a kidney transplant. In the vast majority of cases however we are able to deal with whatever problem turns up!

  • Any operation
    • pain / bruising – inevitably there will be some pain and bruising after the transplant and this can take some time to settle. Pain killers will however be provided!
    • infection – being in hospital and having an operation makes people more prone to chest (particularly in people who smoke), urine and wound infections. We encourage people to get out of bed the day after the operation and do breathing exercises to reduce the chances of chest infection, and we check the urine and wound regularly for any signs of infection.
    • constipation – this is relatively common and we give medication to help the bowels to move
    • blood clot – everyone will receive a small injection under the skin each day and are encouraged to walk around in the first few days to reduce the risk of a blood clot in the legs

 

  • Kidney transplant operation
    • delay in the kidney working – we know that not all transplants will work straight away. This is officially called ‘delayed graft function’ and is due to ‘acute tubular necrosis’ (ATN). This simply reflects the fact that all kidneys that are transplanted experience some ‘insult’ in that they are taken out of one person, have a period of no blood going through them, are kept cold in ice, are handled, and then are stitched into another person. Typically kidneys that are transplanted from living donors work almost immediately, but those from a person who has died can take longer (something catastrophic has happened to the first owner of the kidney, and it takes longer to get the kidney into the patient than with a living donor where everything is planned in advance).
    • drainage problem – uncommonly there can be a problem with the drainage of urine from the new kidney into the bladder. This can be a break down in the join of the drainage tube (ureter) to the bladder causing a urine leak, or else a narrowing of this tube causing a blockage and build-up of urine in the kidney. Sometimes a return to theatre is required to fix this. Such complications tend to be an ‘irritation’ rather than a sinister problem – the issue is not with the kidney itself and the ‘plumbing’ can be fixed!
    • blood flow problem – again there can be two issues, either a leak or a blockage. A leak of blood is usually quickly obvious (abdominal pain and a fall in blood count) and usually will require a return to theatre and an operation to stop the bleeding. This is an uncommon complication and it is even rarer to have a blood clot in the artery or vein of the new kidney. Unfortunately, when there is a blood clot is it usually catastrophic as the kidney has usually died by the time clot is removed in an emergency operation. In such cases the kidney has to be removed.
    • rejection – this still occurs in over 10% of transplants in Belfast. However the vast majority of these can be successfully treated with the variety of medications that are now available. In a small minority the rejection is very severe and aggressive treatment is required. While this means a longer hospital stay and probably more side-effects it is extremely rare that the person does not go home with a working kidney.

What happens to people who get their kidney transplant in Belfast? This is a summary:

  • 80% will work immediately
  • 15% will need dialysis
  • 30% will need a biopsy (small ‘bite’ taken from the kidney with a needle)
  • 15% will have acute rejection (virtually all will be successfully treated)
  • 10% will go back to theatre
  • 33% will be in hospital >10 days (50% will be readmitted in first 12 months)
  • 2% will not work at all (further 2% will return to dialysis within 12 months)
  • >50% will still be working 15 years later

Anyone who has a kidney transplant will be closely monitored in the early days and weeks. This will involve regular blood tests, scans of the kidney, biopsy if required, and attendance at the out-patient clinic twice a week for the first six weeks, and then once a week for a further six weeks.