Most kidney transplants fail due to chronic rejection, a slow, immune-driven attack on the new organ, often triggered by the recipient not taking immunosuppressant drugs as prescribed, but also caused by infections, underlying diseases, or factors like high blood pressure, leading to gradual loss of function over time, even years after the transplant.
Chronic Rejection
This is the most common reason that kidney transplants fail. It is the long-term damage done by the body's immune system for a lot of different reasons. It is important to realize that transplant patients have NO CONTROL over most of these causes of transplant failure.
Infection has been the major cause of death in almost all reports of kidney transplantation,1,4,12,13 both soon and late after transplantation. Multiple organisms are commonly found, and energetic diagnosis and treatment of all infections, especially pneumonia,25 is essential.
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.
Infection Following Kidney Transplant
The risk of infection is greater after transplantation because the immune system has been slowed down by the transplant immunosuppressant medicines, making it harder for your child's body to fight infection.
Signs and symptoms of kidney rejection may include:
On average, a kidney transplant from a living donor lasts for 20-25 years, while a kidney from a deceased donor lasts 15-20 years. This is very variable depending on the age of the donor and patient, and other medical issues. Please speak to your kidney care team for more personalised information.
Chronic rejection has widely varied effects on different organs. At 5 years post-transplant, 80% of lung transplants, 60% of heart transplants and 50% of kidney transplants are affected, while liver transplants are only affected 10% of the time.
About 60% of patients with a failing first kidney allograft are eligible to be waitlisted for a second kidney transplantation, and patients awaiting retransplantation represent 28% of all waitlisted patients in Austria (5–7).
Each transplant program sets its own practice. For example, one program may not accept anyone older than 80 years of age; another may have no age limit. Most transplant candidates nationwide are age 50 or older, and many transplant programs often accept patients age 65 and older.
Silent rejection, also known as subclinical acute rejection, or subAR, is a type of transplant rejection that progresses slowly, often without obvious symptoms.
Avoid alcohol and drugs
Drinking excessively can be dangerous for kidney transplant recipients, as this raises blood pressure.
Dehydration can be harmful to your new kidney. You should aim to drink 2-3 liters of fluid per day. For questions about your diet, call the Transplant Center Dietitian at (916) 734-6528.
While transplanted organs can last the rest of your life, many don't. Some of the reasons may be beyond your control: Low-grade inflammation from the transplant could wear on the organ, or a persisting disease or condition could do to the new organ what it did to the previous one.
Kidneys That Stop Working Stay Put
Surgeons typically don't remove the recipient's native kidneys—unless they're greatly enlarged or causing severe problems, such as high blood pressure or infection. “The nonfunctioning kidneys just get smaller over time,” notes Dr. Gelb.
What can you do to reduce the risk of rejection? Make sure you attend all of your appointments in clinic, and take the medicines that have been prescribed for you. If you have side-effects from your anti-rejection medicines, tell your transplant team so that they can talk to you about other options.
When to seek medical advice
Some organs, like the brain, cannot be transplanted. Tissues include bones, tendons (both referred to as musculoskeletal grafts), cornea, skin, heart valves, nerves and veins. Worldwide, the kidneys are the most commonly transplanted organs, followed by the liver and then the heart.
The truth is, if a transplant recipient lives long enough, every transplanted kidney will fail and most recipients will return to dialysis sooner than they had hoped.
Cornea transplant in humans is almost never rejected.
Lung Transplant: A Challenge Beyond Surgery
Initially, lung transplantation addresses severe, intractable conditions, such as chronic pulmonary failure, but this transplant is one of the most dangerous procedures.
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.
Your belly and side will be sore for the first 1 to 2 weeks after surgery. You also may have some numbness around the cut (incision) the doctor made. You may feel tired while you are healing. It may take 3 to 6 weeks for your energy to fully return.
A kidney transplant is not a permanent cure. It is a replacement that can serve for years, sometimes decades. For a living-donor kidney, average survival is usually between 15 and 20 years, though there are documented cases of grafts working well beyond 30 or even 40 years.
Though you can drink alcohol when you have a transplant, you should keep the number of alcohol units you drink within the recommended government guidelines. Men and women are advised not to drink more than 14 units a week on a regular basis. Also, make sure you keep well hydrated.