Complications of a kidney transplant

Having a kidney transplant, like both haemodialysis and peritoneal dialysis, is not easy. Work is required every day to keep it going. This is partly as it is only moderately effective.

Kidney transplant scar

A fully working transplant provides about 50% of the function of two normal kidneys, i.e. it is not a cure and you remain in CKD5. In fact, many only work at 30-40% function. Nonetheless if it works well enough, it can keep you alive for many years.

However, as for any life-saving long-term treatment, there are complications. We will now go through the early and later complications of a kidney transplant, and focus on the complications of immunosuppressant drugs. These prevent of treat rejection of the kidney.

Early complications

As with any surgery, there may be issues and complications. Potential risks after kidney transplant surgery include:

Bleeding. If severe, this can lead to a rapid return to the operating theatre
Blockage of transplant renal artery or vein (with a blood clot)
Urinary complications. Problems with the ureter, which connects the transplanted kidney to the bladder, can occur, such as blockages or leaks
Rapid loss of the kidney requiring transplant removal (nephrectomy)
Temporary lack of kidney function. Your new kidney may not start working immediately and you may need dialysis until it resumes normal kidney function. This occurs in up to 30% of deceased donor transplants, less in living transplants
Organ rejection. Your body may ‘reject’ (i.e. try to get rid of) the donor organ and you may need extra medication to help your body accept the new kidney. Rejection is most likely in the first year, especially the first three months.

“A good transplant is one with at least 90% function after one year”

Later complications

Blood clots. These occur in the lower legs and lungs, usually in the first month after the operation
Heart attack or stroke. A transplant puts you at a higher risk than a healthy person who has not had a transplant, especially if you have high blood pressure, high cholesterol or diabetes
Narrowing of the transplant artery leading to the kidney – also called transplant artery stenosis. This can lead to very high blood pressure
Transplant failure. Your new kidney may fail after a number of years and you may need to have a second (or third) transplant, or go back on dialysis. Kidneys from living donors last on average about 15 years, and 10 years from deceased donors.

Complications of immunosuppressant drugs

Immunosuppressants prevent your body’s immune system from attacking the new kidney, which would cause the transplanted kidney to be rejected. A combination of 2 or 3 different immunosuppressants – including prednisolone, azathioprine, mycophenolate, ciclosporin and tacrolimus – is usually taken long term.

These drugs can cause a wide range of side effects, including:

Increased risk of infection
Increased risk of diabetes (30% of those on tacrolimus – yes, a very high risk)
High blood pressure
Weight gain
Abdominal pain or diarrhoea
Extra hair growth or hair loss (ciclosporin and tacrolimus respectively)
Swollen gums (ciclosporin)
Bruising or bleeding more easily
Thinning of the bones
Acne
Mood swings
Increased risk of certain types of cancer; particularly skin cancer, and lymphoma (2%, with 80% of those happening in the first two years).

Your doctors will try to find the right dose that is high enough to ‘dampen’ the immune system to stop rejection, but low enough that you experience few or no side effects.

Finding the optimal dose to achieve both goals is often a difficult balancing act. It may take several months to find the most effective dose that causes the least amount of side effects.

Never stop the medication

Side effects should improve once the right dosage is identified. Even if your side effects become troublesome, never suddenly stop taking your medicine, without your transplant doctor asking you to. If you do this, your kidney could be rejected, causing permanent loss of your kidney in 48-72 hours. So never run out of tablets. If you think you are about to, go to your kidney unit, 7 days a week.

Summary

We have described complications of a kidney transplant. We hope you have found it useful.

https://www.youtube.com/watch?v=5GSSggCKW4w

Last Reviewed on 15 October 2023