Kidney transplant surgery

Find out what happens during the transplant operation

Key points

Kidney transplant surgery takes 2-4 hours
You will be put to sleep under a general anaesthetic while the transplant takes place
There are many different ways that a kidney can be transplanted. Your surgeon will explain their preferred technique
You will need special tubes inserted into your arms, neck and bladder for medicines, fluids, and so you can urinate
You will usually only need one kidney to be transplanted. Some patients do require two (dual kidney transplantation)

How is kidney transplant surgery performed?

There are many different ways that a kidney can be transplanted. The surgical team caring for you will explain their preferred technique, and which would be best for you. Most of the time, a single kidney is placed into either the right or left groin (lower abdomen).

How it works

How kidneys are connected

You have a right and left kidney, which are connected to your body via arteries (red) and veins (blue). They are also joined to your bladder.

Illustration showing the position of the right and left kidneys in the body, and how they join to the bladder

Kidneys in close up

This is a close up of a pair of kidneys. The cross section shows how the kidney artery (red) and kidney vein (blue) spread across the kidney. The yellow tube is the ureter, which connects the kidneys to your bladder.

Illustration of the kidneys showing the positions of the kidney artery, kidney vein and ureter

Connecting a donor kidney

The donor kidney is transplanted alongside your own kidneys, and connected at these three points - the kidney artery, kidney vein and ureter.

Illustration showing where the kidney are in the body, with a close up view of donor kidneys and how they would connect to a patient via the kidney artery, kidney vein and ureter

Close up of a transplanted kidney

This shows a transplanted kidney and its different connection points. The stent inside the ureter helps the join heal and is removed several weeks after the surgery.

Illustration of a transplanted kidney connecting to an artery to the right leg, a vein from the right leg and ureter from the kidney transplant with a stent inside

Some things that might happen during your kidney transplant surgery

Removal of peritoneal dialysis (PD) catheter

Tubes will be inserted into your neck, arms and bladder

When you’re asleep, you’ll have plastic tubes (lines or catheters) inserted into your neck, arms and bladder. Before the operation, the surgical and anaesthetic teams will explain where the tubes will be placed.

What are the tubes for?

Small tubes (lines) are inserted into your arms to enable fluid and medications to be given to you during and after the surgery.

For most kidney transplant operations, you’ll also have a tube inserted into the veins in your neck so that stronger medications can be given, if needed. This also lets the team looking after you give you extra fluid, if needed.

A tube (catheter) will be inserted into your bladder via the urethra. Most kidney transplant surgeons will also insert a larger plastic tube into the area around the kidney transplant to drain away any tissue fluid after the surgery.

Risks

Inserting tubes into you can lead to bleeding, infection, or damage to other structures such as blood vessels or nerves. These complications are very rare.

Joins will be made between your blood vessels and those of the donated kidney

Once you are completely asleep, the surgery will start. The blood vessels in your groin will be found, and joins will be made between the blood vessels of the kidney, and your blood vessels. There is usually one join for the vein, and one join for the artery. Blood flow through these vessels will be temporarily stopped when the stitching is being done. Once the blood vessels have been stitched together, blood will be allowed to flow through the kidney and to your legs.

A join is made between the tube that carries urine from the kidney to your bladder

If the surgeon is happy with the blood flow through the kidney, they will then make a join between the tube that carries urine from the kidney (the ureter) to your bladder. Usually, a short piece of soft plastic tubing (a stent) is placed inside the ureter, to help this small join to heal. This is taken out several weeks after the surgery using a simple procedure. After this, your groin and tummy muscles and skin are stitched back together.

There are some patients who have very poor bladder function, or they might not have a bladder at all. Your surgeons will talk to you about how the urine will come out of the kidney transplant and be drained away.

You will usually only be given one kidney

Usually, one kidney is all that is needed for a patient to have a good kidney function after a transplant. However, sometimes the surgeon will recommend putting two kidneys in from the same deceased donor - this is called a “dual kidney transplant”. If your doctors think you might be suitable for a dual kidney transplant, they will discuss this with you.

When a deceased donor has less than average kidney function, both kidneys can be put into one patient to make sure they get sufficient kidney function. This means a bigger operation with a longer scar, or scars on both sides. This operation is not suitable for everyone.

Risks

Having a larger operation is more risky, and your doctors will need to be sure your body can cope with this. The benefits and risks of a dual kidney transplantation will be discussed with you.

A biopsy of the donated kidney might be taken

Many surgeons will take a small piece of tissue (biopsy) of the donated kidney. This can happen just after the kidney is removed from the donor, or when the kidney arrives in your kidney transplant centre, or after the kidney has been transplanted.

Risks

Taking a kidney biopsy is usually very straightforward, but can rarely lead to bleeding from the kidney or damage to the kidney. The risk of serious bleeding or kidney damage from the biopsy is less than one in 100.

Why is a biopsy done?

A kidney biopsy might be taken for research (that is, to find better treatments for kidney transplantation), or to help the surgeons decide if this kidney is right for you or not. Taking a kidney biopsy at the time of surgery (or just before) might also help diagnose problems with your kidney, which may help if there are concerns in the future.

You may receive a paediatric en bloc transplant

If the deceased donor is a very young child, both kidneys from the donor might be transplanted together into the same adult recipient. This is called a paediatric en bloc transplant. If your doctors think you might be suitable for a paediatric en bloc transplant, they will discuss this with you.

Why are both kidneys donated together in paediatric en bloc transplants?

It would be difficult to separate the two kidneys because they come from a small donor, so both are used together in the same patient.
The two kidneys will probably work better than a single kidney transplant

Risks

This is a more difficult operation and it is more common to have problems with the joins between the ureters (urine pipes) and the bladder. It is also more common to have problems with the blood supply, for example blood clots affecting one or both of the kidneys.

En bloc kidney transplants are not suitable for everyone. For example, kidneys from a young donor cannot cope with high blood pressure as easily as kidneys from an adult donor. Your transplant team will not offer you an en bloc kidney transplant if you have a strong tendency to form blood clots (‘sticky blood’), as these can block the very small blood vessels in an en bloc kidney transplant.

In the first few months, en bloc kidney transplants may not work as well as other types of kidney transplants, but they work better over time as they develop.

En bloc kidney transplants grow slowly over time, but you are unlikely to notice this.

It is harder to take a sample of kidney transplant tissue (a biopsy) from an en bloc kidney than from a fully-grown kidney. This means if an en bloc transplant is not working as well as doctors are expecting, they sometimes have to treat the patient for rejection without as much information as they might have for a patient who receive a kidney transplant from an adult.

An example of a kidney transplant technique

After you have been put to sleep under anaesthetic, the surgery will begin.

Your own kidneys will usually be left where they are, unless they're causing problems such as pain or infection. First, an incision (cut) is made in your lower abdomen (tummy), through which the donated kidney is put into place.