Kidney transplant
Surgery that places a healthy kidney from a living or deceased donor into your lower belly, connected to your blood vessels and bladder, to treat kidney failure.
Also called kidney transplantation, renal transplant, KTx, deceased donor kidney transplant, living donor kidney transplant, preemptive kidney transplant, new kidney, get a kidney transplant
- Where
- Transplant center operating room
- Anesthesia
- General anesthesia (you are fully asleep)
- Time in the room
- About 3 to 4 hours
- Hospital stay
- Usually 3 to 7 days
- Going home with
- An internal ureteral stent for a few weeks, removed in the office
- Back to normal
- About 6 to 8 weeks
- Back to work
- Often 6 to 8 weeks; sometimes longer
Overview
A kidney transplant gives you a healthy kidney from another person, called the donor. The donor can be a living person, often a relative, partner or friend, or someone who has died and chose to donate. The new kidney is placed low in the front of your belly, just inside the hip bone, and connected to the large blood vessels that go to your leg and to your bladder. Your own kidneys are usually left in place.
For most people with kidney failure who are healthy enough for surgery, a transplant offers a longer life and better quality of life than staying on dialysis. You no longer need dialysis sessions, and many people feel stronger, eat more freely, and travel more easily.
Your body's defense system will try to reject the new kidney as foreign, so you will take anti-rejection medicines, called immunosuppressants, every day for as long as the kidney works. These medicines also raise the risk of infections and some cancers, so close follow-up is part of life after transplant.
Kidneys from living donors tend to start working right away and last longer. The wait for a deceased-donor kidney is often several years and depends on your blood type, your antibodies, and where you live. You can start building waiting time once your kidney function falls low enough, even before you start dialysis.
The parts of your body involved
Your own kidneys sit high in your back, under the ribs. A transplanted kidney is placed lower, in the front of the pelvis on the right or left side, just inside the hip bone. This spot is close to the iliac artery and vein, large vessels that carry blood to and from the leg, and close to the bladder, so the new kidney's ureter can be joined to it. Because it sits near the skin, the new kidney is easy to check with ultrasound and to biopsy if needed. You may feel it as a firm area under your skin.
- New kidney
Placed in the right or left lower belly. The right side is often used because the vessels lie closer to the surface.
- Iliac artery and vein
Large vessels to the leg that the new kidney's artery and vein are joined to.
- Ureter
The new kidney's drainage tube, joined to the top of your bladder.
- Bladder
Receives urine from the new kidney.
- Your own kidneys
Usually left in place. They are only removed for specific reasons, such as very large polycystic kidneys or repeated infections.
Why it’s done
A transplant is the treatment of choice for many people with kidney failure who are healthy enough for surgery and willing to take lifelong medicines.
- Longer life
On average, people who receive a transplant live longer than similar people who stay on dialysis.
- Freedom from dialysis
No more dialysis sessions several times a week.
- Better quality of life
More energy, fewer diet and fluid limits, and easier travel and work.
- Before dialysis starts
A transplant before you ever need dialysis, called preemptive transplant, gives the best results, most often with a living donor.
Other options
- Hemodialysis
A machine filters your blood, usually 3 times a week for about 3 to 4 hours, at a center or at home.
- Peritoneal dialysis
Fluid placed in your belly through a soft tube filters your blood, done at home each day or overnight with a machine.
- Living donor transplant
A healthy person gives one kidney. It shortens or removes the wait, and these kidneys tend to work longer. If a willing donor is not a match for you, paired exchange programs can swap donors between pairs.
- Conservative kidney care
For some people, especially older adults with other serious illnesses, care focused on symptoms and comfort, without dialysis or transplant, may be the right choice.
Getting ready
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Months to years before
When a kidney is offered
Living donor transplant: the week before
The morning of surgery
In the operating room, step by step
Press play or pick a step. Each drawing shows what your surgeon is doing at that moment. Your team may do some steps differently.
1. Going to sleep and getting ready
You lie on your back and fall fully asleep. The team may place an extra IV in a large neck vein to give fluids and medicines and measure pressures. A catheter is placed in your bladder, and the bladder is filled with sterile fluid so it is easy for the surgeon to find later.
After the operation
In the hospital
- Close watching
Nurses measure your urine every hour at first and check your blood pressure, fluids and blood tests often.
- Ultrasound
An ultrasound with blood-flow pictures is usually done in the first day or two to check the new kidney's blood supply.
- If the kidney is slow to start
Some deceased-donor kidneys need days to weeks to start working well, called delayed graft function. You may need dialysis during that time. It does not usually mean the kidney will fail.
- Learning your medicines
A pharmacist and nurses teach you each medicine, its timing, and side effects. Many people go home with a large pill box and a written schedule.
- Walking and eating
You start walking the next day and eating as your bowels wake up.
- Catheter and drain
The bladder catheter usually stays about 3 to 5 days. The drain comes out when output is low.
- Going home
Most people go home in 3 to 7 days.
At home
- Anti-rejection medicines
Take them exactly on time, every day. Never skip or stop them, even if you feel well. Most people take tacrolimus, mycophenolate and often a steroid. Call if you vomit a dose.
- Frequent lab visits
Blood tests often 2 to 3 times a week at first, then weekly, then less often over months. Tacrolimus levels are measured before the morning dose.
- Preventing infection
Wash hands often, avoid sick people, and wear a mask in crowded places early on. You will take preventive antibiotics and antiviral medicines for several months.
- Food and drink
Follow food safety rules. Avoid grapefruit, pomelo and pomegranate, which change tacrolimus levels. Drink the amount of fluid your team recommends.
- Incision
Keep it clean and dry. Shower when allowed; no baths or swimming until it is fully healed.
- Lifting and activity
Walk daily. Avoid lifting more than about 10 pounds (about 4.5 kilograms) for about 6 to 8 weeks to protect the incision from a hernia.
- Driving
Usually after about 4 to 6 weeks, when you are off opioid pain medicine and can move freely.
- Daily checks
Many centers ask you to record your temperature, blood pressure, weight and urine amount each day at first.
- Skin and sun
Use sunscreen and protective clothing every day. Anti-rejection medicines raise skin cancer risk, so see a dermatologist yearly.
- Pregnancy and vaccines
Wait at least a year before pregnancy and plan it with your team, because some medicines, such as mycophenolate, cause birth defects. Avoid live vaccines.
Recovery timeline
- Day of surgeryTransplant
You wake in recovery, and the new kidney may already be making urine.
- Days 1 to 7In the hospital
Close monitoring, an ultrasound, learning medicines, and going home once stable.
- Weeks 1 to 4Frequent clinic visits
Lab tests several times a week and medicine dose changes.
- Weeks 3 to 6Stent removal
The stent is removed in a quick office procedure with a thin scope through the urethra.
- 6 to 8 weeksBack to most activities
Lifting limits ease and many people return to work.
- First 3 to 6 monthsHighest rejection risk
Rejection is most likely early. Blood tests catch it, often before you feel anything.
- 1 yearA major milestone
More than 9 in 10 transplanted kidneys are still working at 1 year. Visits become less frequent.
- Long termA lifelong partnership
Regular labs, medicines, skin checks and cancer screening. Many kidneys last 10 to 20 years or longer.
What it feels like
A transplant is often described as a rebirth, but the first months are intense: many medicines, many lab visits, and some fear of rejection. Most people say it was worth it.
The call
Excitement, fear and disbelief all at once, often in the middle of the night.
What helpsKeep a bag packed and a ride plan ready. Know that the transplant may still be canceled at the hospital if the kidney is not right, and that this is common.
Waking up
Pain at the incision, many tubes and wires, and often relief and emotion when told the kidney is working.
What helpsAsk for pain medicine early. Let nurses know about nausea.
If the kidney is slow to start
Worry and disappointment if you still need dialysis after the transplant.
What helpsDelayed function is common with deceased-donor kidneys and usually recovers. Ask your team what your daily numbers show.
The first weeks at home
The pill schedule, lab visits and infection precautions can feel overwhelming. Steroids can cause mood swings, poor sleep and a big appetite.
What helpsUse a pill box and phone alarms. Bring a notebook to visits. Ask about lowering steroid doses as allowed.
Stent removal
A brief pinch and pressure during the quick scope test.
What helpsNumbing jelly is used, and it is over in minutes.
Thinking of your donor
Gratitude, and sometimes guilt, especially with a deceased donor.
What helpsMany centers help you write an anonymous letter to the donor family if you wish. Social workers can help you talk through these feelings.
Months later
Many people describe more energy and freedom, and also anxiety before each lab result.
What helpsOver time, stable numbers bring confidence. Peer support groups and transplant social workers can help.
How well it works
Success means the new kidney works well, rejection is prevented or caught early, and you stay healthy on your medicines.
- Kidney function
Creatinine and eGFR blood tests show how well the new kidney works.
- Medicine levels
Blood levels of tacrolimus are checked to keep them in a safe, effective range.
- Early rejection checks
A rising creatinine or new protein in the urine can signal rejection. A biopsy of the new kidney may be done with a needle, and most rejection is treatable.
- One-year success
More than 9 in 10 transplanted kidneys are working at 1 year.
- How long it lasts
On average, living-donor kidneys last longer than deceased-donor kidneys. Many last well over 10 years, and some for decades. If it fails, another transplant is often possible.
Risks
Every operation has risks. These are the ones people ask about most, with honest odds where good numbers exist. Your surgeon’s own results matter more than averages.
Common
Expected for several weeks.
Tremor, high blood sugar, high blood pressure, stomach upset, mood changes and weight gain are common with anti-rejection medicines.
The new kidney is slow to start and dialysis is needed for a short time. Much more common with deceased-donor kidneys.
Urine infections and some viral infections are more common because of the medicines.
Less common
The immune system attacks the kidney. Usually found on blood tests and treated with stronger medicines.
A collection of lymph fluid near the kidney. Small ones go away; large ones may need draining.
At the join between the ureter and the bladder. May need a stent, a tube or a repair.
Infection, slow healing or a hernia at the incision, more likely with obesity and steroids.
Some anti-rejection medicines raise blood sugar.
Rare
Can cause loss of the kidney, usually in the first days.
Can raise blood pressure later. Often treated with a balloon or stent through a blood vessel.
Skin cancer is more common, and lymphoma risk is higher, because of the medicines.
Rarely the kidney fails early. You can return to dialysis and the waiting list.
Call your care team or go to the emergency room if
- Fever of 100.4°F (38°C) or higher, or chills (call even for a lower fever if you feel unwell)
- Much less urine than usual, or no urine
- Pain, tenderness or swelling over the new kidney
- Weight gain of more than 2 to 3 pounds in a day or 5 pounds in a week, or new swelling in the legs
- Vomiting or diarrhea that stops you from keeping down your medicines
- Blood pressure much higher than your usual
- Redness, drainage or opening of the incision
- Chest pain, trouble breathing, or signs of stroke (call 911)
Questions to ask your surgeon
- Am I a good candidate for a transplant, and what would make me a better one?
- How long is the wait for my blood type at this center?
- Can I get on more than one center's list?
- Would a living donor be better for me, and how do donors start?
- Would you accept a kidney with higher risk factors to shorten my wait?
- Which anti-rejection medicines will I take, and what are their side effects?
- How often will I need lab tests and visits?
- When will the stent come out?
- What signs of rejection or infection should I watch for?
- How will insurance cover my medicines long term?
- When can I return to work, drive and travel?
Words you may hear
- Kidney failure (end-stage kidney disease)
- Kidney function so low that dialysis or a transplant is needed to live.
- Donor
- The person who gives the kidney, living or deceased.
- Recipient
- The person who receives the kidney.
- Crossmatch
- A blood test that checks whether your body already has antibodies against the donor.
- Immunosuppressants
- Anti-rejection medicines that calm the immune system.
- Tacrolimus
- A common anti-rejection medicine whose blood level is checked often.
- Rejection
- The immune system attacking the transplanted kidney.
- Delayed graft function
- A new kidney that is slow to start working, sometimes needing dialysis for a short time.
- Graft
- The transplanted kidney.
- Iliac vessels
- Large blood vessels in the pelvis that carry blood to and from the leg.
- Ureteral stent
- A thin tube inside the ureter that protects the join to the bladder while it heals.
- Lymphocele
- A pocket of lymph fluid that can collect near the new kidney.
- Paired exchange
- A program that swaps donors between pairs who are not matches, so each recipient gets a compatible kidney.
Common questions
Do they take out my old kidneys?
Usually not. Your own kidneys stay in place unless they cause specific problems, such as very large polycystic kidneys, repeated infections, or a suspicious mass.
How long will the new kidney last?
It varies. On average, living-donor kidneys last longer than deceased-donor kidneys, and many last 10 to 20 years or longer. Taking your medicines exactly as prescribed is the biggest thing you can do to help it last.
Can I stop my medicines once the kidney is working well?
No. Stopping or skipping anti-rejection medicines is one of the most common reasons a transplanted kidney fails, even years later.
Will I feel the kidney?
Some people can feel it as a firm area under the skin of the lower belly. That is normal.
What if it fails?
You can return to dialysis and, in many cases, be listed for another transplant.
Can I have children after a transplant?
Many people do. Plan pregnancy with your team, usually waiting at least a year with stable kidney function, because some medicines must be changed beforehand.
Sources this page draws on
- KDIGO (Kidney Disease: Improving Global Outcomes), Clinical Practice Guideline on the Evaluation and Management of Candidates for Kidney Transplantation (2020)
- KDIGO (Kidney Disease: Improving Global Outcomes), Clinical Practice Guideline for the Care of Kidney Transplant Recipients (2009)
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Kidney Transplant
- National Kidney Foundation, Kidney Transplant
- New England Journal of Medicine, Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant (Wolfe et al.) (1999)
Written November 2026. This page explains what usually happens. It is not medical advice and does not replace a conversation with your own surgeon, whose plan for you comes first.