Kidney Transplant

Treating kidney disease through transplantation

Three Scripps Health kidney transplant experts having a discussion in a medical facility waiting area.

Dr. James Rice, Transplantation Nephrology, Scripps Clinic

Treating kidney disease through transplantation

Since 1994, Scripps Organ Transplantation Program has been helping patients with end-stage kidney disease through our kidney transplant program. Today, our kidney transplant program continues to have success rates that match or exceed the national average.

Expert care for kidney transplants

Our team of experts is here to help you though every step of the kidney transplantation process. Working as a multidisciplinary team, our kidney transplant surgeons and other specialists combine their skills and expertise to ensure you receive the best possible outcome, before, during and after your kidney transplant surgery.


In addition, Scripps offers a living donor program to help kidney transplant patients find a donor kidney faster. Scripps was the first in San Diego to perform a three-paired kidney exchange between six people, and recently participated in the first international kidney exchange.

Understanding your kidney transplant

Most people have two kidneys, which are located in their back just below the rib cage. Your kidneys have several important functions, including:


  • Removing waste and excess fluid from the blood
  • Controlling the body’s chemical balance
  • Assisting in the creation of new red blood cells
  • Regulating blood pressure


Some injuries and conditions — including kidney failure, polycystic kidney disease, infections, hypertension or glomerulonephritis — can damage the kidneys and limit their ability to function. If this happens, you may need to have your blood regularly cleaned through a process called dialysis, or you may be eligible for a kidney transplant.


During a kidney transplant surgery, a donor kidney is surgically placed in the lower abdomen near the major veins and arteries in the pelvis. The new kidney begins to clean the blood immediately. The damaged kidneys are often left in place unless they are badly infected or enlarged from polycystic kidney disease.

Frequently asked questions about kidney transplantation

If you need a kidney transplant, you may have many questions about kidney transplant surgery and what to expect. Here are answers to frequently asked questions about kidney transplantation. Always feel free to ask your physician or care team for more information and guidance.

What is a kidney transplant?

A kidney transplant is a surgical procedure that places a healthy kidney from a live or deceased donor into a person whose kidney is failing and can no longer function properly.

Why is a kidney transplant necessary?

The kidneys are two bean-shaped organs located just below the rib cage on either side of the spine. They filter waste and excess fluids and eliminate these from the body in the form of urine. If a kidney is damaged due to illness or injury, it can lead to kidney failure, and harmful amounts of waste and fluid can build up in the body. Most people can live with just one functioning kidney, but if both kidneys are damaged, a kidney transplant may be necessary.

When will I be placed on the kidney transplant wait list?

After you have completed the necessary medical tests and received insurance approval for a kidney transplant, the transplant selection committee at Scripps will review the results ensure it is safe for you to undergo transplant surgery. At that time, you will be placed on the wait list for a kidney donation.

Why are there so many tests?

The tests are part of the evaluation process and are required to make sure it is safe for you to receive a transplant. For example, if you were found to have heart disease during your evaluation, you may need a new medication or procedure before it would be safe for your heart to undergo transplant surgery.

How long will it take to complete the tests?

The entire evaluation process may take from one month to several months, depending on your condition and how quickly you can complete the necessary tests.

How long will I have to wait for a kidney transplant?

Several factors determine how long you will need to wait for your kidney transplant, including:

 

  • How quickly you complete the evaluation testing
  • The results of your evaluation testing
  • Whether you have other medical conditions that require a waiting period, such as cancer treatment
  • Your blood type (certain blood types typically wait longer than others)
  • How your immune system reacts to cells or organs from other individuals
  • How long you have been on dialysis and on the wait list


If the kidney is coming from a cadaveric (deceased) donor, patients generally may wait months to years for a transplant. For patients with a living kidney donor, the wait can be significantly shorter because they need to wait only as long as it takes to complete both their evaluation and that of their donor (usually a few months). In addition, patients with kidney failure who agree to accept a kidney from an extended criteria donor could possibly reduce their wait time and improve their quality of life.

How long will the transplanted kidney last?

In most cases, the new kidney should last for the rest of your life. However, several factors may affect this timeframe, including:


  • Recurrence of the disease that damaged your original kidney
  • Rejection of the new kidney by your immune system
  • Infection
  • Reaction to a medication you are taking


Fortunately, in most cases these problems can be treated.

What are immunosuppression medications?

When you first go home after your transplant, you will need to take approximately 10 to 12 new medications. These medications lower or “suppress” your immune system, so that it will accept a kidney from someone else. Without these medications, your immune system would reject and attack your new kidney.


Immunosuppression medications have a number of side effects, including raising your risk of certain infections. Some patients cannot take traditional steroid-based drugs for immunosuppression. These patients may qualify for steroid-free immunosuppression.

Will I have to take immunosuppression medications for the rest of my life?

Over time, your transplant physician will reduce the number of medications you take, but you will need to take some immunosuppression medications for life.

How long will my recovery take?

You will be in the hospital for about a week after your kidney transplant surgery. When you go home, you will need help taking care of yourself. If you are an out-of-town patient, you will need to plan to stay locally following your transplant for as long as your physician recommends.


For the first four to six weeks, you must avoid lifting anything heavier than a phone book. Some patients recover quickly, but some need more time. Your recovery also will depend on how ill you were before your transplant and whether you have any complications after the surgery.

How soon can I get back to my normal life after my kidney transplant?

Most patients can get back to a relatively normal life about three months after a kidney transplant. It will probably be two to three months before you are ready to drive, and probably three to six months before you are ready to go back to work.

I have been told I am highly sensitized. Can I still receive a transplant?

Highly sensitized people have a very sensitized immune system that would likely attack the transplanted kidney. If you have a potential kidney donor to whom you are sensitized, you may be a candidate for the desensitization protocol at Scripps and entrance into paired donation. In certain cases, this protocol can remove the sensitization and make the transplant possible. Please ask your physician for more information if you have a donor to whom you are sensitized.

My potential donor and I have different blood types. Can I still receive a kidney from this person?

In certain circumstances, donors of one blood type can give a kidney to a recipient with a different blood type. Your potential donor may still be able to donate a kidney to you. Some cases require special medications, and some do not. Paired donation may be an option. Please ask your transplant coordinator for more information if you have a donor who has a different blood type.

What is paired donation?

A paired donation happens when a potential living kidney donor is not a compatible match for the recipient, but is a compatible match for another patient who has an incompatible donor. The donor and recipient then exchange kidneys with another donor/recipient pair who also are not compatible, but each donor is a compatible match with the other pair’s recipient. This is also known as a “kidney swap” because the living kidney donors are, in effect, swapping recipients. 

Freedom from dialysis after a kidney transplant

At Scripps, our goal is to help people eliminate the need for dialysis with a successful kidney transplant — even for people who have a complex diagnosis, advanced age or other factors.


Our kidney transplant program helps patients spend less time on the transplant waiting list through numerous protocols not available at every transplant facility. These include:


ABO-incompatible kidney transplants 

Special protocols make it possible to transplant across blood types.


Steroid-free immunosuppression

We offer specific protocols for patients who cannot tolerate traditional steroid-based drugs for immunosuppression.


Cross-match positive kidney transplants 

Our program uses techniques which can, in many cases, remove the antibodies that would cause a transplanted organ to be rejected.


Kidney transplants for patients with HIV infection 

Our team can help patients with stable HIV infection manage the complex drug interactions between transplant and HIV medications.


Living kidney donation 

Despite ongoing efforts to encourage organ donation after death, there are still not enough kidney donors in the US to meet the need, and more patients join the wait list each year. Our living kidney donor program allows friends, family members and altruistic donors to help those in need of a kidney transplant. Learn more about becoming a living kidney donor.


Kidney donor exchanges 

Potential donors who are unable to donate to their own loved ones can choose to donate to each other’s loved ones in what is essentially a “swap,” or exchange.

Expanded criteria donor kidney transplants

The expanded criteria donor (ECD) is considered an “older kidney” and taking an older kidney enhances the opportunity to be transplanted sooner than waiting for a younger or standard criteria kidney (SCD). 


The specific criteria of an ECD kidney is any donor over the age of 60, or a donor over the age of 50 with two of the following:


  • A history of high blood pressure
  • A creatinine (blood test that shows kidney function) greater than or equal to 1.5
  • Death resulting from a stroke


Sometimes the function of a single kidney from an ECD organ would not be sufficient. In this situation, a pair of kidneys with limited function can be transplanted into a single patient. This type of transplant is called a dual-kidney transplant. Research shows that this option offers outcomes that are just as good as a single-kidney transplant with normal function and can effectively address the shortage of donor organs.


You can decide whether to accept an ECD kidney and you will be asked to consent to this in writing. Intuitively, an ECD kidney will not last as long as a younger SCD kidney. However, the one-year graft survival is estimated at over 80% for ECD vs greater than 90% for SCD and five year rate of function kidney is excellent. For older patients, this may be the best approach before age related complications preclude transplantation. 


Whether you receive SCD or ECD kidneys, there is a low rate of needing dialysis for days or weeks, and in rare cases, there is risk of the kidney not working. Kidney transplants have a superior survival when compared to remaining on dialysis. You should discuss with your nephrologist whether to consent to ECD kidney offers.

Living kidney donation

Despite ongoing efforts to encourage organ donation after death, there are still not enough kidney donors in the United States to meet the need, and more patients enter the wait list each year. Our living kidney donor program allows friends, family members and altruistic donors to help those in need of a kidney transplant. Learn more about becoming a living kidney donor.

Our approach to transplants

At Scripps, we treat the person, not the illness. Our patient-centered approach combines a multidisciplinary team with the most advanced treatments and technology available in San Diego and beyond.

Your transplant care team

In addition to our surgical expertise, our strengths include a broad range of medical and support services, such as our multidisciplinary team of caregivers, including:


  • Transplant coordinators
  • Financial coordinators
  • Social workers
  • Transplant dietitians
  • Immunologists
  • Pharmacists


Your transplant care team will be your partner through the transplant process and beyond. We’ll work closely with your insurance carrier, referring primary care physician, hepatologist, nephrologist and other specialists involved in your care to ensure all of your health care needs are addressed with efficiency and compassion.


The Scripps transplant team is composed of an established, multidisciplinary panel of surgeons and nephrologists who are nationally recognized as leaders in their field at the forefront of the latest advancements and treatment options. 


Our patient and graft survival rates continue to remain above the national expected average, and we outperform our regional competitors in shorter lengths of stay. 


This team is complemented by a comprehensive medical staff specially trained to care for transplant patients, and provides the full range of services our patients need to be successful.

Individualized care

Our approach to medical care ensures that all of our patients receive treatment plans that are customized to their individual needs. For example, patients who cannot take traditional steroid-based drugs to prevent organ rejection following a transplant may qualify for steroid-free immunosuppression.

Clinical research for transplantation

In order to discover new treatment options and better transplant methods, our physicians participate in a variety of research activities.


View our list of active clinical trials at Scripps Health.

Support groups for transplant patients and caregivers

Our program provides free, monthly support groups for organ transplant patients and their families. The groups are designed to share coping strategies, express frustrations and concerns, as well as share hope and support.

Liver and kidney transplant support group

For those considering transplant, in evaluation for transplant, waiting for transplant or those who have had a transplant, we offer a support group on the first Wednesday of every month from 6–8 pm. Transplant Education and Support Groups

Caregiver support group for liver and kidney disease

To offer comfort and support for caregivers of those with kidney and liver disease, we host a support group on the third Tuesday of every month from 6–7 pm. It can be comforting to discuss things with other caregivers and receive guidance from a medical professional. Support Group and Events Schedule

Patient support and resources

Scripps offers a wide range of supportive services to meet the specialized needs of transplant patients and their loved ones, including support groups and educational classes. Learn more about the support and resources you have access to at Scripps. Our inspirational transplant patient success stories are another great resource to learn more about the supportive, life-affirming aspects of Scripps transplant services and care.