Early risks of a kidney transplant

In every 100 patients receiving a kidney transplant from a deceased donor, delayed graft happens in between 20 and 60 patients.

Delayed graft function is when your transplanted kidney doesn’t start working straight away.

After a kidney transplant from a deceased donor, it can take a few days, or even a few weeks, for the kidney to ‘wake up’ and start working. This is very common and is called ‘delayed graft function’. The majority of kidneys do eventually ‘wake up’ but you may need dialysis while you are waiting for this to happen.                    

Learn more about delayed graft function

On average 10 to 20 out of every 100 patients will need a blood transfusion within the first week of surgery.

With any operation there is a risk of bleeding. If it happens during the operation, the surgeon can usually stop it with extra stitches or special medications. Patients who take blood-thinning medications (for example, warfarin) have a higher risk of bleeding.

A blood transfusion is very common in the first week after a kidney transplant. Sometimes, patients who have had a kidney transplant will need to go back to the operating theatre for more surgery to stop the bleeding, as well as having a blood transfusion.

A blood transfusion carries risks such as fluid overload, production of antibodies, or (very rarely) disease transmission. Your kidney transplant team will discuss these with you and will give you a leaflet that explains these in more detail.

Between 10 to 20 in every 100 patients need extra antibiotics for an infection within the first week of kidney transplant surgery.

Infections are very common after a kidney transplant, in part because you will be given immune suppressing medicines. These medicines reduce the risks of you rejecting your kidney, but they also lower your immune system’s ability to fight infections.

Learn more about risk of infections

Between 10 to 15 in every 100 patients experience rejection during the first year after a transplant.

Rejection is when your body’s immune system starts to ‘attack’ your transplanted kidney. It happens when your immune system recognises the kidney as coming from a different person and thinks it isn’t supposed to be there.

After a kidney transplant, patients need to take powerful medicines (‘immunosuppressants’) to help stop rejection happening. Even if you take your anti-rejection medicines carefully, rejection can still occur. This is why your transplant team will closely monitor your health and kidney function after your transplant.

Learn more about rejection

If you have diabetes before the kidney transplant, it is likely that your blood sugar will be more difficult to control after the transplant. Your transplant team will help adjust your medications to improve your blood sugar control.

• If you take tablets to control your diabetes before the transplant, it is possible that you will need insulin to control your diabetes after the transplant
• You can help lower the risk of diabetes after a transplant by losing weight and exercising

5 in every 100 patients experience nerve damage.

Nerves around the area of the kidney transplant may be damaged. A patch of numbness around the wound or on the front of the thigh on the same side of the transplant is the most common problem, but this almost always gets better by itself.

Weakness to the nerve that controls the muscles around the knee is more serious, but much less common. This affects about 1 in 1000 patients.

Between 3 to 5 out of 100 patients need further surgery within the first few weeks or months after the kidney transplant.

There are many different reasons why further surgery might be needed, including:

1. Your new kidney isn’t working as well as it should be

Affects 3 to 5 out of 100 patients

If a transplanted kidney is not functioning as well as expected, more surgery may be required to inspect the organ to see whether it can be made to work better.

2. Build up of tissue fluid

Affects 3 to 5 out of 100 patients

Tissue fluid can build up around the kidney, and this can sometimes push on the kidney or the veins around the kidney. This can cause the kidney to stop working or cause leg swelling. Sometimes the fluid can become infected. Surgery may be needed, or your kidney transplant team may ask the special X-ray team (interventional radiologists) to place a draining tube into the fluid collection.

3. Wound infections, bleeding into the wound or other organ damage

Affects 1 to 2 out of 100 patients

Further surgery may be needed due to wound infections, bleeding into the wounds or damage to other organs caused by the transplant surgery. This might include damage to the intestines (bowel) or liver or spleen, or to the blood vessels leading to and from the leg.

This happens in 2 to 4 people out of 100 patients.

Sometimes the new kidney never starts working. If this happens, your kidney transplant team might recommend that the transplant be surgically removed.

There are many reasons why a kidney transplant might never work (also called ‘primary non-function’). These reasons include:

• A blood clot within the blood vessels that leads to or from the kidney transplant that can’t be removed
• Severe early rejection of the kidney which is resistant to anti-rejection treatment
• Severe early recurrence of your original kidney disease
• Sometimes it is not possible to know why the kidney never worked

Between 2 to 3 out of 100 patients experience blood clots inside the transplanted kidney.

A blood clot can form within the artery leading to the kidney, or the vein draining blood from the kidney. This might require emergency surgery, or you might go to special X-ray (interventional radiology) to have a thin wire put inside your blood vessels to remove the clot.

If a blood clot forms within the blood vessels of the kidney it can be very difficult to successfully treat. Often the kidney transplant needs to be removed completely.

Some patients are prone to forming blood clots. These patients are at increased risk of blood clots within the kidney and are likely to need medication to keep their blood thin after the surgery.

Between 2 to 3 out of 100 patients experience urine leaks from the kidney transplant.

The urine leak usually comes from the join between the tube carrying urine from the kidney transplant (the ureter) to your bladder. Leakage of urine can be repaired surgically, or can be treated by re-insertion of a catheter (tube) into the bladder. Your kidney transplant team will discuss these options with you.

Heart problems affect between 1 to 5 people in every 100 patients.

Heart problems can occur soon after the kidney transplant. This may be due to a blockage in the blood supply to the heart (‘heart attack’) or problems with the rhythm of the heartbeat.

If your doctor thinks you might be at risk of major heart problems, they’ll test your heart function before you go on the transplant list.

• Even if your heart tests are normal, it is still possible that you may have heart problems after the kidney transplant due to the stress of the operation.
• A heart attack happens when there is a blockage in the blood supply to the heart muscle. This usually happens when there is thickening inside the walls of the heart arteries.
• Good treatments are available for both a heart attack, and for problems with the heart rhythm. These treatments include blood thinning medication, or medications to settle the heart rhythm. Sometimes heart doctors (cardiologists) may need to place tubes into the heart arteries to try to unblock them. Sometimes a pacemaker might be needed.

About 1 in every 100 patients experience deep vein thrombosis.

Blood clots can form within the deep veins of the leg. These clots can break off and travel in the bloodstream to the lungs, causing lung and heart problems. Blood clots in the deep leg veins are called a deep vein thrombosis (DVT). If they travel to the lung it is called a pulmonary embolus (PE).

How your care team aim to prevent DVT:

• You will be encouraged to get out of bed as soon as you can after a kidney transplant to reduce the risk of these blood clots forming.
• Tight stockings help reduce the risk of DVTs and PEs. These should be worn while you are in hospital, and until the transplant team tell you that it is safe to remove them. Some patients should not wear tight stockings, for example if you have major blood flow problems in your leg arteries.
• Blood-thinning medication is usually given to patients after a kidney transplant to reduce the risks of DVTs and PEs. However, these blood thinners can increase the risk of bleeding after surgery so a balance needs to be found.

This affects fewer than 1 in every 100 patients.

A stroke (a blockage of the blood supply to the brain) can happen soon after a transplant. Strokes are more common in older patients and in those who have had a stroke before.

This might happen in about 1 in every 200 attempted kidney transplant operations.

Sometimes the kidney transplant operation starts, but the surgeon is unable to finish the kidney transplant. This is uncommon.

Reasons for this include:

• Serious anaesthetic complications that mean it would be dangerous to proceed with surgery (for example, reactions to the anaesthetic or other medications, or serious heart or lung problems)
• Major bleeding that cannot be controlled unless the kidney transplant is removed
• Severe diseases of the arteries or veins that mean that connecting them to the kidney transplant is dangerous
• Serious problems with the blood flow within the kidney transplant that mean the kidney has to be removed during the same operation
• Severe rejection of the kidney that cannot be treated during the operation
• New information about the deceased donor or kidney that was not available before the operation started (for example, finding a cancer in the donor)

Fewer than 2 in 1000 patients experience severely damaged blood supply to the leg.

During a kidney transplant, the surgeons need to temporarily stop the blood supply to and from your leg. The blood supply to your leg is then restored, but sometimes there can be problems with the arteries and veins supplying your leg. If this does occur, it is possible that the leg on the side of the kidney transplant may no longer work. You may need another operation to repair the blood vessels or even to remove the leg (amputation).

Fewer than 1 in 1000 patients will get cancer from a donated kidney.

It is very rare for cancer to be transmitted with the donated kidney. Every effort is made to be sure that a kidney donor does not have a cancer that could be passed on to you during a kidney transplant. The risk of dying while waiting to receive a kidney transplant is much greater than the risk of receiving a kidney that has cancer in it.

You may be offered a kidney transplant team from a donor known to have had cancer. This will only happen if the transplant team think that the risk of the donor’s cancer having spread to the kidney is low. You do not have to accept a kidney from a donor who has had cancer. This will be discussed in detail with you.

Recurrent disease is when your original kidney disease comes back and damages your new kidney transplant.

The chance of this happening depends on the cause of your kidney disease. For some diseases, this is common, for others, very rare.

Sometimes the disease can come back very quickly (within hours or days), and sometimes very slowly (after 5-10 years).

Your kidney transplant team will tell you if there is a significant risk of your kidney disease coming back and damaging the transplanted kidney.

On average, 1 to 2 in 100 patients die during the first few months after a kidney transplant. However, this varies widely on a patient-by-patient basis.

There is a risk of dying during the kidney transplant operation, or during the first few weeks or months afterwards. This is usually due to the stress of the surgery on your heart and lungs, or because of serious complications such as infections, heart attacks or strokes.

Each patient has a different risk of dying after the operation. The risk of dying is higher in older patients, and in those who have major heart, lung, blood vessel or liver disease. The risk of dying in the first few months after a kidney transplant can be as low as 1 out of every 1000 patients, or as high as 1 out of every 20 patients. If your kidney transplant team believe that you have a higher than usual risk of dying after a kidney transplant, they will talk to you about this.

It is important to remember that your kidney transplant team won’t recommend that you have a kidney transplant if they believe that the risks of the operation are unacceptably high.