Nottingham Kidney Transplant Unit

Who is suitable for a kidney transplant?

All patients under the care of the Nottingham and Derby Renal units with end stage kidney disease will be assessed for suitability for a kidney transplant, although in reality only around 30% of patients will be suitable. Patients with a progressive worsening of kidney function and medically suitable for transplantation will be offered the option of being placed on the national transplant list within six months of their anticipated dialysis start.

Some patients with kidney failure due to diabetes may be suitable for a kidney and pancreas transplant. This will be discussed when you see the surgeon in Nottingham, and if appropriate you will be referred to the transplant unit at Addenbrooke’s in Cambridge to see if you would be suitable for a combined transplant.

How will we know if I am suitable?

Your kidney specialist (nephrologist) in Nottingham or Derby will do this initial assessment with you and arrange the necessary investigations which will include blood tests, a chest x-ray, a heart tracing and sometimes more detailed tests of your heart and blood vessels. If these tests are OK you will be referred to one of the transplant surgeons in Nottingham.

As part of the surgical assessment you will be asked to watch our video presentation which you can access via the following link: https://youtu.be/jZNxnrlF21Q

You may find it helpful to watch this with members of your family. 

You will also be given a combined appointment with the transplant surgeon and pre-transplant nurse specialist for a Thursday afternoon clinic. The surgeon will assess your suitability for a transplant including whether live donation is possible, and explain more about the options, risk and benefits of a transplant. If you are suitable, then you will be taken through the consent process and then see the specialist nurse who will give further information. You will then have further blood tests for tissue typing and antibody testing which will help to find the best possible kidney for your transplant. Once these results are available the pre-transplant nurse specialist will contact you to let you know when you are on the national transplant list.

Being on the transplant list

The national transplant list is not a waiting list as such, but rather a list of people waiting for a kidney from a deceased donor. The average wait for a deceased donor transplant in Nottingham is around two years, but may range from a few days to many years. Deceased donor kidneys are allocated nationally on a points based system based on a number of factors including blood group, best match, antibody levels, waiting time and donor-recipient age difference.

If however you have a suitable live donor, then there are a number of benefits of a live donor kidney transplant. The short and long term results are better, the operation can be done at a time that is more convenient for you and the waiting time is shorter.

What happens whilst I am on the transplant list?

Whilst you are waiting on the transplant list you will be seen by a transplant surgeon once a year. This will be in addition to your usual kidney clinic appointments. You should also have three monthly blood tests performed for antibody levels.

You will be asked to let the specialist nurse know if you go on holiday or if you are admitted to hospital or are suffering from an illness requiring treatment from your GP. In some of those situations you will need to be temporarily suspended from the transplant list and this will be explained in more detail before you go on to the list.

Live donor kidney transplant

You will normally be asked to come to a pre-op clinic the week before the operation to meet the surgeon, the kidney specialist, the anaesthetist and the live donor specialist nurse to make sure that both the donor and recipient are fit and ready for surgery. The surgeon will talk through the details of the operation, the benefits and risks and ask you to sign a consent form. You will usually be asked to come into hospital the night before your operation which will be done on a routine operating list with the donor operation being done in the morning followed by the transplant operation in the afternoon.

Deceased donor kidney transplant

You may get a phone call day or night to say that we have been offered a potential kidney for you. Sometimes we may be able to tell you some hours before hand and sometimes we will want you to come to the Transplant Unit as soon as you are able. There are a number of checks that need to be done before we are able to go ahead with the transplant and it may be the transplant isn’t possible on this occasion.

When you arrive we will need to check that you are medically fit for a transplant and you will see the surgeon, the kidney specialist and the anaesthetist who will talk through the details of what will happen. We will need to do a special blood test, called a cross match test, to ensure that the kidney is compatible with you. Assuming you are fit and the kidney is compatible, the surgeon will examine the kidney as a final check and the transplant operation can then proceed.

What happens in hospital after I’ve had a transplant?

You will come back from theatre with various tubes in place and you will be closely observed. Most transplants from living donors work immediately and around two thirds from deceased donors, but if the kidney is slow to work you may need some dialysis. Over the following few days the tubes will be removed and you can start to move around more. You can expect to be in hospital for 5-7 days and before discharge the dietician and the transplant nurse specialist will discuss with you what you need to know, and give you an appointment for transplant clinic.

After discharge, you will be expected to attend clinic 3 times a week for the first 2 weeks and then come less often as you get better. You will be seen more frequently earlier on so that we can pick up and deal with any problems promptly. Generally after 2 months you will be coming weekly, after 4 months every fortnight, and after 6 months every month until your kidney is a year old. If you are a patient from Derby your care will usually be transferred back to the Derby nephrologist at 3 months.

On most clinic visits you will see one of the transplant nurse specialists, but also the transplant surgeon a number of times in the first six months and the nephrologist yearly after that. The aim is to keep you and your kidney healthy for as long as possible and you will be seen in the transplant clinic for as long as your transplant works.

There are a number of benefits of a live donor kidney transplant. The short and long term results are better, the operation can be done at a time that is more convenient and the waiting time is shorter. However removing a kidney from a live donor is a major operation which is of no benefit to the donor themselves and it is important that you fully understand the options, risks, and benefits. Most live donors will be known to their recipients, but some live donors offer to give their kidney to someone they don’t know.

You will also have a detailed set of blood and urine tests and scans done to ensure that you are otherwise fit and well and that you have two kidneys that are both working equally well, as well as an assessment from a transplant surgeon and kidney specialist. Finally you will see an Independent Assessor as we have a legal requirement to ensure that you have given consent, are not being coerced and have not been offered a reward.

If you want to find out more about being a live donor contact the live donor coordinators on 0115 969 1169 ext 59405.