Longer-term risks of a kidney transplant

Infections are very common, even many months or years after a kidney transplant.

The most common infections are chest or urine infections. These are usually fairly straightforward to treat with antibiotic tablets.

Some infections come from the donor kidney

The most common of these is a virus called CMV (cytomegalovirus). This virus infects more than half of healthy people and, after the initial infection, remains dormant in the body for the rest of your life.

Learn more about the risk of infections

Rejection happens in 10 to 15 out of 100 patients within the first year of a kidney transplant.

The risk of rejection is highest in the first 3-6 months after a transplant. After this time, your body’s immune system is less likely to recognise the kidney as coming from another person. Even if you take your anti-rejection medications, rejection can still occur. This is why it’s important to keep your appointments in clinic and take the tablets that have been prescribed for you.

Learn more about rejection

This happens in 5 to 10 out of 100 patients after a kidney transplant.

A hernia is an area of weakness in your tummy muscle layers where the kidney has been implanted. This occurs if the deep layers of the scar don’t heal properly. A hernia is not usually dangerous, but sometimes needs further surgery.

• Many patients with hernias through the kidney transplant scar have few symptoms, though they can be unsightly. If there is a lot of discomfort, or if the hernia stops you from doing daily activities, surgery might be needed. Your kidney transplant surgical team can advise you.
• Wound healing in kidney transplant patients is not as fast as wound healing in other patients. This is because of the effect of previous kidney problems, and because the immunosuppressant tablets also slow down wound healing. Being overweight or obese, smoking, and too much heavy lifting soon after the transplant can also increase the chance that a hernia might occur.
• After you have had a kidney transplant, you should avoid heavy lifting (that is, more than 10kg weight) for at least 6 weeks after their surgery. Please speak to the kidney transplant team if you need further advice. If your job requires heavy lifting, you will need to speak to your surgical team about when it is safe to return to your usual duties.
• Repair of the hernia requires further surgery, and often needs a mesh to be inserted into your tummy wall to strengthen the wound. Hernias can come back again, even after repair.

This happens in 1 to 5 out of 100 patients.

The join between the transplanted kidney’s artery and your own artery might become scarred and narrowed. If the blood supply to the kidney is reduced, and causing problems with the kidney, this scarred area might need to be stretched. This will help improve blood flow to the kidney transplant. This usually doesn’t require further surgery, but can be done by X-ray specialists (interventional radiologists) using wires and balloons inside the blood vessels.

• Narrowing (stenosis) of the kidney transplant artery is suspected if your blood pressure becomes hard to control despite tablets or if your kidney function gets worse for no other obvious reason. Scans of the arteries are needed to find out if there are any narrowings. Stretching the artery from inside the blood vessel has some risks (for example, it may cause bleeding, or may damage the arteries). Your kidney transplant team will discuss this with you.
• The transplant team and radiologists may recommend leaving a small tube inside the artery to keep the narrowed area open (this is called a stent). You may need blood thinning medications to help reduce the risk of blood clots within the stent.

This happens in 1 to 5 out of patients after kidney transplant surgery.

The tube carrying urine from the kidney to your bladder might become narrowed. This tube is called the ureter. This narrowing may slow the flow of urine out of the kidney and cause a drop in the function of the kidney transplant. This can be treated with further surgery to remove the narrowed area, or sometimes a plastic tube (stent) can be placed within the narrowed area to keep it open.

• Narrowing of the ureter is suspected if the kidney transplant function drops and if scans show a hold up of urine inside the kidney transplant (hydronephrosis). The narrowing usually happens at the join between the ureter and your bladder, although it can happen anywhere along the ureter tube.
• Narrowing of the ureter can be due to other problems, such as stones inside the kidney transplant. Sometimes cancer in the ureter or the bladder might cause a narrowing, although this is rare.

This affects fewer than 1 in 100 patients

A stroke (a blockage of the blood supply to the brain) can occur many months or years after transplant. It is important to stop smoking, take regular exercise, keep a healthy body weight, and have good blood sugar and blood pressure control. Doing these things will reduce the risk of a stroke. Strokes are more common in older patients, and in those who have had a stroke before.

There is a higher risk of some types of cancer following a transplant.

Skin cancers are particularly common in kidney transplant patients. Other cancers, such as lymphomas, are also more common in kidney transplant patients.

What you can do:

• Avoid staying out in the sun for long periods, and wear factor 50 sunblock and a long-sleeved shirt and a hat if you are in the sun.
• It is strongly recommended that you attend any cancer screening tests, such as a mammogram, cervical smear or bowel cancer screening.
• If you notice a lump, something unusual on your skin or anything else that you’re worried about, please let your transplant team know.

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

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 risk of your kidney disease coming back and damaging the transplanted kidney.

You will need to take powerful medicines after a kidney transplant.

You may experience side effects to your transplant medicines. Different kidney transplant centres use different medicines to prevent rejection and infection in their patients. Your own transplant centre will tell you about the medicines they will prescribe after your transplant, and the most common and most important side effects that you need to know about.

In general, medicines for kidney transplant patients include:

Immunosuppressants

To reduce the risk of kidney rejection.

The doses of these medicines usually reduce over time, but some medicines will be needed for the lifetime of the kidney transplant. All immunosuppressants increase the risk of infection, and of some cancers.

• Tacrolimus: in high doses, this can impair kidney function. Blood tests are needed to make sure the correct dose is given. Blood sugars can be raised.
• Steroids (e.g. prednisolone): this can cause high blood pressure, increased appetite and thinned skin. Blood sugars can be raised.
• Mycophenolate mofetil: this can cause diarrhoea or nausea. The number of white cells in the blood can be reduced. Women who wish to get pregnant and are taking mycophenolate mofetil should discuss with their transplant team if they need an alternative immunosuppressant.

Antibiotic and antiviral medicines

To reduce the risk of infection.

These usually stop between 3 and 12 months after a transplant, but your transplant team will advise you about this.

Other medicines

• Medicines to lower blood pressure, reduce blood sugar levels, or reduce the risk of blood clots.
• Medicines to protect the lining of your stomach, as some immunosuppressants and blood thinners can cause stomach irritation
• Medicines that you may need for other health issues

Learn more about medications after a kidney transplant

Heart problems can happen many months or years after the kidney transplant operation

These problems may be due to a blockage in the blood supply to the heart. This is called a heart attack. A heart attack happens when there is a blockage in the blood supply to the heart muscle. This usually happens when there is thickening of the walls of the heart arteries.

Good treatments are available for a heart attack. These include blood thinning medication and medication to improve the blood flow to the heart muscle. Sometimes heart specialists (cardiologists) may need to place tubes into the heart arteries through blood vessels in your groin, wrist or elbow in order to inspect the heart arteries and try to unblock them.

What you can do to reduce the risk of a heart attack:

• Stop smoking
• Take regular exercise
• Keep a healthy body weight
• Maintain healthy blood sugars and blood pressure

Three quarters of patients (75 in 100) are alive 10 years after a kidney transplant

There is a risk of dying following the transplant. This risk is highest in the first few weeks or months after the operation. Rarely, patients can die within a year or two of a kidney transplant.

It is important to remember that your transplant team won’t recommend that you have a kidney transplant if they believe that the risk of the operation is higher than the benefits. For most patients, the risk of dying if they stay on dialysis is higher than the risk of dying if they have a kidney transplant.