For Pre-Transplant Patients

Researchers and surgeons have found that placing the kidney in the pelvis was more successful than placing it in the back. In addition, this means the native kidney(s) does not have to be removed, which simplifies the surgery.

Yes.

Three to five days.

Four to six weeks.

With living donors, about 80% of transplanted kidneys will last at least 10 years. With non-living donors, about 60% of transplanted kidneys will last at least 10 years.

Patients who do not have a living donor are placed on the waiting list for a cadaveric transplant (a kidney from someone who has died). The allocation of organs on the waiting list is based on a point system. The point system is based on several factors, including the match, how long the patient has been waiting, and the immune status of the patient.

When a donor becomes available anywhere in the country, the blood type and tissue type of the donor is determined. That information is compared to the tissue typing of all patients waiting for a transplant with that blood type. A computerized list is generated through The United Network for Organ Sharing (UNOS) in Richmond, Virginia. This list shows if there are any perfect matches for this particular donor in the country. If so, patients who are a perfect match are given the most priority for that particular donor. After the perfect matches are determined, then the rest of the patients with that blood type are listed according to how many points they have.

Each surgery, one for the donor and one for the recipient, lasts approximately 3 - 5 hours.

A typical schedule of post-transplant follow-up visits is as follows:

  • Two visits in the week following your transplant and the following four weeks.
  • One visit per week months 2-3. Further follow-up is determined by how well your recovery is progressing.

During this process, our post transplant team will keep your nephrologist informed of your progress. Eventually, as your kidney or kidney and/or pancreas become healthy, your nephrologist will resume the role of primary caregiver.

Most patients must take multiple medications following their transplant. These medications are necessary to fight organ rejection and bacterial and viral infections. The anti-rejection medications must be continued throughout the life of the kidney or kidney and pancreas. Other medications may include antibiotics, antivirals, antihypertensives, diuretics, vitamins, iron, and drugs to prevent stomach ulcers as needed.

For Post-Transplant Patients

Monitor your temperature and blood pressure twice daily and:

  • Call for temperature of 101.0 ºF or greater.
  • Call for blood pressure greater than 200 systolic (the top number) or greater than 100 diastolic (the bottom number).
  • Call for weight gain of more than 5 pounds.
  • Call for any new or unusual symptoms.
  • When you are ill, monitor your temperature every 4 hours or if you feel chilled.
  • Take Tylenol: 650 mg (two 325 mg tablets) every 4 - 6 hours as needed.
  • Call us or go to the emergency room if your temperature is greater than 101.0 ºF.
  • Claritin
  • Benadryl (Diphenhydramine) 25 - 50 mg every 6 hours as needed. Also good as a mild sleep aid.
  • Robitussin DM 1 - 2 tsp every 4 - 6 hours

Tylenol 650 mg (two 325 mg tablets) every 4-6 hours as needed.

Do NOT take any non-steroid anti-inflammatory medications (also known as NSAIDS) such as Ibuprofen (Advil, Motrin), Naprosyn (Aleve). These medications are harmful to the kidney. Please avoid any combination over-the-counter medications because many of the products have NSAIDS as pain or fever relievers.

  • Skin cancer prevention is very important. Use sunscreen regularly and see a dermatologist regularly if you are light-skinned or have skin lesions, such as moles.
  • If you are a diabetic, please see a podiatrist regularly for foot care.
  • Before having any dental procedures, even routine cleaning, you should take preventative antibiotics. Please inform your nurse prior to the procedure so antibiotic prophylaxis.
  • (prevention) can be coordinated with your dentist or oral surgeon.
  • See your primary care doctor for regular check-ups.
  • Follow a prudent diet and get plenty of exercise.
  • Maintain a healthy weight.

For Waitlisted Patients

Wait time for a donor organ depends on several factors. These include your blood type, tissue matching, presence of preformed antibodies (protective proteins produced by the immune system in response to the presence of a foreign substance), and the time from which you began dialysis.

Expected patient waiting times vary depending upon your geographical location within the United States as well as the local Organ Procurement Organization (OPO).

The following websites provide information regarding the organ transplant wait list, waiting times, and organ donation.

Average wait times in the D.C., Maryland, and Virginia region are:

  • Blood Group A: 3 years (1095-1190 days)
  • Blood Group B: 5-6 years (1838-2125 days)
  • Blood Group O: 5 years (1778-1891 days)
  • Blood Group AB: 2 years (578-866 days)

As of December 4, 2014, your wait time will be calculated from the day you started dialysis (not the date you completed your evaluation).

  • For patients listed before they started dialysis, your time will still be calculated from your date of listing.

We typically like to see patients once a year while on the waitlist so that we can keep updated on medical issues that might affect getting a transplant.

For patients with more complex medical issues, we may see you as frequently as every 6 months.

While we may only be in touch with you every 6-12 months, you should always feel free to contact us at 202-444-3700. Your coordinators while on the waitlist are Vera Kirichenko and Aleya Akhran (at our MedStar Georgetown offices) or Eloida Gonzalez (at our MedStar Washington Hospital Center offices).

We would like to hear about any significant changes to your medical condition:

  • Before any planned elective surgery
  • Any time you have surgery
  • Any time you require an overnight hospital stay
  • Any abnormal screening tests ordered by your primary care provider

We want to know about any change in your contact information:

  • Any time you move or change your phone number
  • Any change in your dialysis center
  • Any change in your nephrologist or primary care doctor

We want to know about any change in your insurance information:

  • When you change insurance plans, we need to make sure that you still have coverage for all of the needed post-transplant medications.

Monthly blood testing. We need a sample of blood sent to our lab every month you are on the list. We use this blood to test you against the donor kidneys to make sure you are a match. If we do not have blood from you, we cannot test the kidneys, and you will not be offered a transplant.

  • If you are on dialysis, your dialysis unit should be taking care of this. Be sure to check with your dialysis center that this is being done. If you are not yet on dialysis, you should receive the required supplies in the mail so that you can have the blood drawn locally.

Annual testing for hepatitis and other viruses

  • We will do this for you at your annual visits to the transplant center.

Annual chest X-ray and electrocardiogram

Heart testing (a stress test and an echocardiogram) every 2 years

You must keep current with standard screening tests including (as appropriate):

  • PSA tests yearly (men over 50)
  • Mammograms every 1-2 years (women over 40)
  • Pap smears every 2-3 years (all women)
  • Colonoscopies every 5-10 years (all patients over 50)

Stop using all tobacco products (cigarettes, cigars, pipes, dip).

  • The use of tobacco products affects your immune system. It makes you more likely to get an infection, but also makes the immune system more likely to attack the kidney. Some studies have found that people who smoke are eight times more likely to lose the kidney than people who do not smoke. You should speak to your doctor about programs and medications that may be appropriate for you to help you quit smoking.

If you are diabetic, it is very important to have good control of your blood sugar prior to your transplant. Immediately following your transplant, you will likely need adjustment to your regimen, and this is easier to accomplish if your sugars were in good control prior to the transplant.

  • Keep your weight well controlled. Surgical complications increase for patients who are more overweight. We look at the body mass index (BMI), which adjusts for how tall you are. You can calculate your own BMI by using a site like National Heart, Lung, and Blood .
  • Patients with a BMI above 40 will not be offered a kidney.
  • Patients with a BMI above 35 are at higher risk for complications.
  • Ideally, patients will have a BMI at or below 30 at the time of their transplant.

Your time on the list now starts from your first day of dialysis.

  • Even if you were listed after many years of dialysis, those years will be added to your total waiting time.
  • For patients listed before they are on dialysis, their time will start at listing, so there is still a large advantage to being listed before starting dialysis.

Kidneys expected to last the longest will be given to patients who are expected to live the longest.

Kidney quality will be described by the Kidney Donor Profile Index (KDPI).

Expected Post Transplant Survival (EPTS) will be calculated by your age, your time on dialysis, whether you have diabetes, and whether you have already had a transplant.

  • The top 20% of kidneys (KDPI) will go to the top 20% of recipients (EPTS).

There will be no further need to transfer time between transplant centers. Your time on the list will be the same at all centers at which you are listed, based on when you started dialysis.

If you are a U.S. citizen, or a legal permanent resident who has lived in the country for 5 years, you are eligible for Medicare once you are on dialysis.

If you never applied for Medicare while on dialysis and now receive a transplant, you can still qualify for Medicare coverage.

Regardless of when you applied for Medicare, if you are not 65 years old or on disability, your Medicare coverage will end 3 years after you receive your transplant.

  • If you received a living donor transplant, you should continue your Medicare for the full 3 years allowed. Your donor’s medical expenses will no longer be covered once you give up Medicare.
  • Patients on Medicare should consider what insurance options will be available to them once this 3 year deadline arrives.

If you have Medicare, make sure you have Medicare Part A, B, and D (coverage).

  • Part B is the portion of your insurance that covers your physician fees and your anti-rejection medications. Medication costs alone can run $3,000-6,000 per month after transplant.
  • Even with full Medicare coverage, Medicare will only pay for 80% of your doctor’s fees and medication costs. Without additional (secondary) coverage, you will be responsible for 20% of these costs post-transplant. These costs can be hundreds or even thousands of dollars. We strongly advise you to find secondary insurance in addition to Medicare.

Know what your current insurance coverage is and who is paying for it.

If any of your insurance premiums are paid by the American Kidney Fund, you should know that the American Kidney Fund will not pay for your premiums post-transplant. You will be responsible for these premiums post-transplant.

The MedStar Georgetown Transplant Institute has financial coordinators who are experts in transplantation and insurance coverage. If you are concerned about your coverage, please call us. Our coordinators will be happy to advise and assist you in getting the best possible coverage for your transplant needs.

  • If you are concerned about adequate health care coverage, we encourage you to apply for secondary insurance through your state’s Healthcare Exchange Plan. More information about this can be found at healthcare.gov

For Living Donors 

One to three days.

In two weeks.

Each surgery, one for the donor and one for the recipient, lasts approximately three - five hours.

There is very little risk associated with being a kidney donor, either short-term or long-term. Short-term, the risk of dying from the surgery is about 0.03% (3 in 10,000). Major complications are unusual. In the long-term, having been a donor does not influence the donor’s risk of kidney failure, high blood pressure, or diabetes.

Questions About the Kind of Kidneys That I Might Receive

Patients can receive a kidney either from a living donor (living donor kidney: LDK) or a deceased donor (deceased donor kidney: DDK). An LDK is superior to a DDK in several ways. Kidneys from living donors work more quickly with fewer complications and last longer than kidneys from deceased donors.

KDPI is a way of describing which organs will tend to do better over time.

Each organ is given a score between 0 and 100. The lower the number, the better the kidney.

  • The score is based upon 10 factors measured in the donor
    • Age
    • Height
    • Weight
    • Ethnicity
    • Hypertension
    • Diabetes
    • Cause of Death
    • Kidney Function
    • Hepatitis C Status
    • Donor Cardiac Death

  • KDPI is used only for deceased donors
  • KDPI replaces earlier categories such as Expanded Criteria Donors (ECD) and Donor Cardiac Death (DCD).

    • ECD kidneys are roughly equal to kidneys with a KDPI of 85-100. If you had previously considered receiving an ECD kidney, you should consider kidneys with a KDPI of 85-100.
    • If you previously signed a consent to receive ECD kidneys, you will automatically be listed as willing to accept kidneys with a KDPI of 85-100. You may, of course, change your decision at any time by calling the Transplant Institute and speaking with your coordinator. Even if you consent to receive a high KDPI kidney you continue to have the right to refuse any offer made to you.

    Kidneys with a KDPI of 0-20 will only go to recipients who are estimated to have the best expected post-transplant survival (EPTS). These recipients will tend to be those who:

    • Do not have diabetes
    • Have not had a prior transplant
    • Are younger
    • Have spent a shorter time on dialysis

All donors are screened for potential communicable diseases at the time of organ allocation. This includes screening for hepatitis B, hepatitis C, HIV, and syphilis.

All CDC high risk organs have tested negative for HIV, hepatitis B, and hepatitis C.

However, certain higher risk groups may have a negative test after recently catching the virus. These high risk groups are:

  • Men who have sex with other men
  • Users of IV, intramuscular, or subcutaneous injection of drugs
  • People who have had sex in the preceding 12 months with a person in any of the categories above
  • Inmates
  • People who cannot be tested for HIV infection
  • People whose history, exam, or medical records reveal other evidence of HIV infection or high-risk behavior

Although the exact risk of transmission is unknown, we can estimate the risks in these groups:

  • For HIV, the risk is between 1 and 5 in 10,000
  • For hepatitis C, the risk is between 1 and 30 in 10,000
    [Data from Kucirka et al. (2011) Current Opinion in Organ Transplantation 16:256]

Donors that test positive for the hepatitis B core antibody are patients who have been infected with the hepatitis B virus in the past.

These donors do not have any evidence of active hepatitis B infection.

If you have not already been vaccinated against the hepatitis B virus, your chances of being infected with the hepatitis B virus from a hepatitis B core positive donor are between 1 and 3 in 1000.

  • Even with this low rate of disease transmission, active hepatitis does not usually occur.
  • With continued follow up, the rare occurrence of hepatitis B disease transmission from a hepatitis B core positive donor is not likely to adversely affect your health.

If you receive a transplant from a donor who is hepatitis B core positive, you will receive a medication (lamivudine) after your transplant. In addition, your hepatitis B status will be closely followed with blood tests at several time points after your transplant.

By accepting offers from hepatitis B core positive donors, your chance of receiving a quality organ with less waiting time is increased.

Questions About Living Donor Kidneys

Donors can be anyone who is healthy enough to donate:

  • They do not have to be related to you.
  • They do not have to be of the same age, race, or sex as you.

The kidney you receive must be of a compatible blood type:

  • Blood group A recipients can receive from Blood Group A or O (75% of all people).
  • Blood group B recipients can receive from Blood Group B or O (50% of all people).
  • Blood group O recipients can receive from Blood Group O (45% of all people)
  • Blood group AB recipients can receive from all blood groups.

You cannot have any antibodies against the kidney you receive.

  • People can make antibodies against a kidney in the following ways:
    • They have received blood transfusions.
    • They have been pregnant.
    • They have had a prior transplant.

  • If any of these situations apply, let the transplant institute know so that we can re-test your antibody levels
  • Even if you know you have a donor who is incompatible, they may still help you get a transplant through a paired kidney exchange.

    Even if you looked for a potential living donor in the past it’s important to always think of new possibilities.

Potential donors must contact the Transplant Institute. If you have someone who is interested in being a living donor he or she can contact the donor liaison at 202-444-3714

Make an Appointment

For more information or to schedule an appointment with a kidney transplant specialist, please call our scheduling line:

855-546-0645

Research & Clinical Trials

Research is a critical part of what we do at MedStar Georgetown University Hospital. Learn more about our research on treating and managing advanced disease and transplantation surgery.

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