Long-term issues

Long-term issues

How long will my kidney last?

The outcome for both the kidney transplant and the person who was transplanted has been improving over the past four decades. There are different factors that will influence how long a transplant will work:

  • Donor factors – a kidney will generally last longer if it is from a living rather than deceased donor, a younger rather than older donor, and a healthy donor rather than someone who has had high blood pressure or diabetes
  • Early transplant factors – a short time from when the kidney is removed from the donor until it is transplanted, a very good match, and not having an episode of acute rejection are all associated with a better long-term outcome
  • Recipient factors – a younger person, a healthy person with minimal time if any on dialysis, and someone who maintains a moderate healthy lifestyle (and takes all their recommended tablets) will all do better and their kidney transplant will last longer

While neither the transplanted organ nor the patient last forever, we can take steps to help both last as long as possible.

For the kidney

What causes transplant kidneys to fail? In some cases there are particular problems such as the original disease that caused the patients’ own kidneys to fail coming back and affecting the transplant kidney, or problems with the drainage of the kidney, or frequent infections. The accumulation of chronic injury from the immune system is a more common problem, and emphasises the need to continue to take the anti-rejection medication as directed. Overall kidneys that have been transplanted, particularly from a deceased donor, will have had considerable additional insults (compared to a normal non-transplanted kidney) and can ‘wear out’ sooner.

In NI in 2014 there are over 200 people with a kidney transplant still working over 20 years since their operation, and half a dozen people are still living with a working kidney for over 40 years (one man and his transplant are still going strong after 44 years!). So it is very possible to live for a long time with a functioning transplant – if it is a good kidney and well looked after! Overall there is a steady improvement in NI in how long transplants last.

Clearly if an older person, (or someone of any age with many other health problems), receives a transplant it is likely that it will last them for their lifetime. A younger person however is very likely to require more than one transplant. In NI 37 people have had three or four kidney transplants. It does become more challenging both technically (to put in another kidney) and in getting a suitably matched kidney, so it is obviously important for everyone with kidney failure to get as long as possible from their own kidneys before being transplanted and to ‘obey the rules’ so that a transplanted kidney will last as long as possible.

For the person

The three main long-term health problems experienced by transplant recipients are cardiovascular disease (heart problems, strokes, and hardening of the arteries), cancer and infection. Obviously cardiovascular disease and cancer are relatively common problem in our population in general, but they can occur at a younger age in people with chronic kidney disease or those who have been transplanted.

  • Cardiovascular disease: having even mild chronic kidney disease is associated with a higher risk of disease of the heart arteries or arteries elsewhere in the body. However this hardening of the arteries can happen much more quickly when people require dialysis treatment. The risk of this can definitely be reduced by sticking to the fluid restriction and dietary advice given, and keeping fit and active. Part of the reason why people with a kidney transplant have cardiovascular disease is therefore because they ‘bring with them’ the problems already caused by kidney failure and dialysis. It is ideal to have a transplant without needing a long period on dialysis first. A lot can be done to reduce the chances of hardening of the arteries once someone is transplanted e.g. regular exercise, avoiding becoming overweight, having very good blood pressure and cholesterol etc.
  • Cancer: the immune system normally detects cells that are abnormal looking and seeks to destroy them. This includes cells that are reproducing in the wrong way (potential cancer cells) well as cells that are infected. When the immune system is suppressed for a long time (to prevent rejection) there is a higher chance of developing some types of cancer. Most common by far is skin cancer, and obviously there are many things that a person can do to reduce the risks of developing skin cancer. It is also particularly important that a transplanted person attends when called by their GP for screening tests (for cervical smear, breast or bowel screening).
  • Infection: someone who is on immunosuppressive drugs is likely to get sicker than an average person when they get an infection. It is important that they contact their doctor sooner rather than later if they are not getting better.

Since anti-rejection medications play a part in the higher risk of these complications, the doctor will seek to reduce the amount of these tablets that you have to take. The goal is the ‘minimum effective dose’ i.e. just enough to stop rejection. The difficulty is that the amount of anti-rejection medication required is not the same for everyone, and there is no easy way of measuring this! However the consultant at the transplant clinic will be the best person to guide on the doses of anti-rejection drugs required. It is very important to remember that failing to take the medication prescribed will almost certainly mean the need for dialysis treatment, and overall this is very much worse in terms of long-term health than transplantation (even with the medication and associated risks).