Kidney Transplantation

01 Overview

Kidney transplantation replaces failing renal function with a donated kidney, offering better survival and quality of life than long-term dialysis for suitable candidates. It is the most commonly performed solid organ transplant worldwide and can use kidneys from living or deceased donors.

02 Anatomy

The transplanted kidney is usually placed extraperitoneally in the iliac fossa rather than replacing the native kidneys, which are typically left in place. The renal artery and vein are anastomosed to the recipient's iliac vessels, and the donor ureter is implanted into the bladder.

03 Physiology

A single transplanted kidney is generally sufficient to sustain normal excretory, acid-base, fluid, and endocrine function — including erythropoietin production and vitamin D activation — once adequately perfused and free of rejection or obstruction.

04 Indications

Transplantation is considered for patients approaching or established on renal replacement therapy due to irreversible kidney failure, most commonly resulting from:

• Diabetic nephropathy
• Glomerulonephritis
• Polycystic kidney disease
• Hypertensive nephrosclerosis
• Congenital or reflux nephropathy

05 Contraindications

Assessment aims to identify factors that would make transplantation unsafe or unlikely to succeed, including:

• Active, untreated malignancy
• Active uncontrolled infection
• Severe uncorrected cardiovascular disease
• Very limited life expectancy from comorbidity
• Non-adherence unlikely to be overcome with support

06 Donor Assessment

Living and deceased donors undergo evaluation of renal function, anatomy, and general health, alongside screening for transmissible disease and malignancy, to confirm suitability and anticipate surgical risk.

07 Recipient Assessment

Recipients are evaluated for cardiovascular fitness, infection risk, malignancy history, and psychosocial readiness, with tissue typing and cross-matching performed to gauge immunological compatibility with the donor.

08 Surgical Technique (Summary)

The operation is performed through a lower abdominal incision, with vascular anastomoses to the iliac vessels followed by ureteric reimplantation into the bladder, usually over a temporary ureteric stent.

09 Immunosuppression (Overview)

A combination of induction therapy and maintenance agents — typically a calcineurin inhibitor, an antiproliferative agent, and corticosteroids — is used to reduce rejection risk while balancing infection and toxicity.

10 Complications

Recognised complications include:

• Acute or chronic rejection
• Vascular thrombosis
• Ureteric leak or stricture
• Delayed graft function
• Infection related to immunosuppression

11 Follow-up

Long-term follow-up monitors graft function and immunosuppressant levels, and screens for cardiovascular disease, malignancy, infection, and recurrence of the original kidney disease.