Kidney Transplant — What to Expect

Referral to a transplant centre starts once eGFR falls below 20 or dialysis has begun. The assessment includes blood tests, heart tests (ECG, echocardiogram, sometimes angiogram), lung function, cancer screening, infection screening (hepatitis, HIV, TB), and dental review. You will also meet the transplant surgeon, nephrologist, specialist nurse, dietitian, and social worker. The process takes several months. Being listed does not guarantee a transplant — it means you are eligible when a suitable kidney becomes available.

In the UK, deceased-donor kidneys are allocated by NHS Blood and Transplant using a national computer system. Priority is based on: tissue matching (HLA compatibility), waiting time, age match, and a points score that rewards dialysis time and tissue match quality. People who are highly sensitised (have many antibodies against donor tissue) wait longer. The UK also has a paired/pooled scheme where incompatible donor-recipient pairs swap kidneys with other pairs.

Living donors undergo extensive health checks to ensure donation is safe. They must be over 18, in good health, and have normal kidney function. Donors can live perfectly well with one kidney — the remaining kidney compensates by growing larger. Recovery takes 4–6 weeks. In the UK, living donors are covered by the NHS for life for any donation-related healthcare. Altruistic (non-directed) donation — giving to a stranger — is legal and increasingly common.

In the first week, the transplant team monitors urine output, blood tests (creatinine, tacrolimus levels), and checks for bleeding or clots. Dialysis is sometimes needed briefly if the new kidney is slow to start. Most people go home after 5–7 days with a large supply of medicines and a strict follow-up schedule. Clinic visits are frequent at first — weekly, then fortnightly, then monthly — with blood tests before each visit.

Diet: avoid grapefruit and grapefruit juice (they interact with tacrolimus and ciclosporin). Avoid unpasteurised dairy, raw shellfish, and undercooked meat (infection risk). Limit salt to control blood pressure. Exercise: walking and gentle activity start within days; swimming and gym exercise can resume after 6–8 weeks once the wound has healed. Travel: avoid live vaccines (yellow fever, BCG, oral typhoid). Carry a letter listing your medicines. Declare your transplant to travel insurers. Sun protection is critical — immunosuppressants increase skin cancer risk.

Contact your transplant team urgently if you develop: reduced urine output, fever, pain or tenderness over the transplant, swelling, or feeling generally unwell. These can signal rejection or infection — both are treatable if caught early. Do not wait for your next clinic appointment.