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Kidney Transplant Overview

Kidney transplant background
Transplant or dialysis?
Kidney transplant statistics
Who can get a kidney transplant?

Once patients reach End Stage Renal Disease (ESRD) they will require treatment to perform the function usually performed by the kidney. Two options are available: dialysis and transplantation. Dialysis involves using a machine (hemodialysis) or special fluid placed in the abdomen several times per day (peritoneal dialysis). Along with medication and diet restrictions, these treatments can allow patients to live with renal failure for many years.

Transplantation offers patients with renal disease the opportunity to be free from dialysis. During a kidney transplant, a new kidney from a living donor—or from a patient who has died—is placed within the patient with kidney failure (recipient) by a surgical procedure. A kidney transplant gives the recipient a new kidney that will provide all of the necessary kidney function, and allow him or her to return to a full and active life.

Kidney transplant background

Transplant surgery began in the early 1960s. Initially, transplantation was limited to identical twins. Next, new medications allowed transplantation between non-identical relatives, and eventually from unrelated donors, including deceased donors.

Patients were initially treated with very strong medications to prevent rejection of the new kidney. As a result, patients often became ill simply from these medications, and needed to stay in the hospital for a long time.

Since the early days of transplantation, over 100,000 people have received renal (kidney) transplants. Over the last 40 years, a kidney transplant has become a routine procedure. Patients are usually in the hospital for no more than 3-5 days and can return to a very active life. The medications have improved significantly and now have very few side effects for the recipient.

Transplant or dialysis?

A kidney transplant allows for a regular diet and greater independence than dialysis (removing waste from the blood by a machine). A transplant will likely allow you to return to work. For an appropriate candidate, kidney transplantation is a life-saving procedure. Compared to patients on dialysis, patients receiving a kidney transplant live longer and have a better quality of life.

Kidney transplant is not right for every person on dialysis. People with certain conditions are not eligible for transplantation. These conditions include severe heart disease, active or recent cancer, active infection (including HIV), and the inability to understand and participate in your medical care.

The other main disadvantage of a kidney transplant is that you will have to take medication every day, exactly as prescribed, for as long as the kidney works. This may mean for the rest of your life. The drugs have side effects that may cause a variety of other problems. There is a very small increase in some types of infections and cancers—including lymph node and skin cancer—after a kidney transplant.

It is important to remember that this choice is ultimately your decision. The Dartmouth-Hitchcock transplant team will work with you and your nephrologists (kidney specialists) to determine which treatment is best for you.

Kidney transplant statistics

  • More than 10,000 kidney transplants are performed each year
  • 95% of the people who have kidney transplants are alive after one year compared with a 90% chance of being alive after the first year of dialysis. For patients with certain conditions—such as diabetes—the risk of death on dialysis is even higher.
  • If the kidney comes from a living donor, the success rate is higher than if the kidney came from a deceased person (cadaveric donor). The survival of the transplanted kidney itself is 75% to 85% at one year when it is from a deceased, unrelated donor, as compared to over 90% when the kidney is donated by a living person.

Who can get a kidney transplant?

Anyone who has kidney failure can be considered for a transplant, except those with an active infection, cancer, HIV (human immune virus), an autoimmune disorder, obesity, significant heart disease, or severe vascular disease. To become a candidate for transplantation, you must complete a series of medical tests. If you are approved, the transplant team will explore options for donated kidneys. There is often a waiting list for non-related, cadaveric kidneys.

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