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Key points.

• Possible problems after a transplant
• Risks of immunosuppression
• General side effects of taking immunosuppressant drugs

Possible problems after a transplant

Although a transplant is an excellent treatment for most people with kidney failure, transplantation is not problem-free. Most of the complications are due to two factors.
First, many people having a transplant have other health problems in addition to kidney failure. These can include diabetes, high blood pressure, heart disease, or other complications of being on dialysis.

Secondly, the body recognises a transplant as an invader, in the same way it would recognise a germ. This means that the body will try to destroy the transplant, and this is what is called rejection. Rejection can be prevented by drugs, but all these drugs interfere with the good things the immune system does, as well as preventing rejection. Therefore, infections and cancers occur as side effects. In addition, the anti-rejection drugs cause complications such as high blood pressure, high cholesterol and diabetes. All these can lead to a heart attack or a stroke.

Research is being done all over the world to try and develop anti-rejection treatments that do not cause all these complications, but this research has not been fully successful yet. Having said that, the drugs available now are better than a few years ago and the numbers of complications that occur have been reduced markedly.

Risk of dying after a transplant

Within one year of any transplant, a small percentage of people die, about 3% (three out of one hundred) in most units. However, this is no greater than the percentage that would have died if they had remained on dialysis. Long term survival depends very much on not getting heart problems and cancer. There are many patients who have had a functioning transplant for over 20 years and who are very well. However, on average, about 70% (seven out of ten) transplant recipients are alive ten years after a transplant.

The other main complications of transplantation are:

1. problems with the transplant kidney itself, such as rejection, or problems with the blood supply or urine drainage (see leaflet      Transplant Rejection)
2. infections, such as urine infection or pneumonia, (see leaflet Infection after Kidney Transplant)
3. high blood pressure, high blood glucose levels and high cholesterol levels, (see leaflet on Blood Pressure)
4. cancer, which is most commonly a skin cancer (see leaflet Cancer after Transplant)

There are risks associated with all major and minor operations, which can lead to serious complications or even death. The transplant operation and the days immediately after it carry the same risks. These will have been explained to you by the transplant coordinators, kidney doctor (nephrologists) and surgeon during your pre-transplant assessments. They will be explained to you again at the time of your transplant before you sign the consent form.

The risks for patients undergoing kidney transplantation:

The kidney failing in the first year -    7-10 out of 100

Bleeding needing blood transfusion -   10 out of 100

Problem with the join between the kidney and the bladder - 10 out of 100

Blockage of the blood vessels supplying the kidney - 4 out of 100

Narrowing of the blood vessels supplying the kidney - 5 out of 100

Wound infection -  5-10 out of 100

Collection of fluid around the kidney - 15 out of 1-00

Blood clots in the legs - 1-3 out of 100

Acute rejection of the new kidney - 20 out of 100

Risks of immunosuppression

*Approximately 1 in 2000 donors have a hidden cancer or 1:100 an infection that we do not know about, we cannot predict which donors have these hidden cancers or infection, even though the assessments are quite robust and viruses are checked for. Such diseases may be inadvertently transmitted to you from such high risk donors and thus the need for further treatment for example with antivirals. You will be counselled about potential risks and complications. You can choose not to accept such a kidney if you feel these risks are high.

Your consultant may feel that it is in your best interest to receive a blood transfusion during or after the transplant. The reasons for a blood transfusion will be discussed with you before the operation. The risks of blood transfusion are low and you will receive a leaflet about this.

You may develop other conditions related to receiving a kidney transplant. However the risks are very small and the consultant will discuss these with you fully before the operation prior to you signing your consent form.

Potential side effects of specific drugs and general side effects of taking immunosuppressive drugs.

The drugs stop you rejecting the kidney by weakening your immune response. A consequence of this is that you are more susceptible to some infections and cancers. The infections tend to be viruses or other infectious agents that are already in your body at the time of the transplant. They may also be in the transplanted kidney, rather than infections that you catch from other people. The most common virus to cause problems is called cytomegalovirus. Some patients are given a drug called valganciclovir to prevent infection.
Transplant patients are more likely to get skin cancer and it is important to take precautions to avoid sunburn. Two out of every 100 patients transplanted will get a cancer of the blood called lymphoma.

Potential side effects of specific drugs

Tacrolimus

• Tremor of your hands
• Hot flushes and tingling in the hands and feet.
• Increase in blood pressure
• Increase in blood cholesterol
• Diabetes in 10 of every 100 patients transplanted
• Nightmares (first two weeks)
• Constipation and wind pains (first two weeks)

Prednisolone

• Weight gain due to increased appetite
• Round “moon” shaped face which can change how you look
• Increase in blood pressure
• Diabetes
• Personality change - very rarely
• Osteoporosis (thinning of the bones)

Mycophenolate mofetil

• Abdominal cramps and/or diarrhoea
• Abnormality of bone marrow function. This may make you more susceptible to infection or bleeding and it may result in you becoming anaemic..

The side effects are related to the dose of the drugs, which are reduced gradually over the first three months. They may be treatable, for example with blood pressure tablets. Many are self-limiting and they will usually go within a few days or weeks of the transplant. These do not need to be treated.

Last reviewed January 2024
Next review January 2027

Reviewed by
Dr. Oluwafemi Efuntoye, Transplant Fellow, University Hospitals Coventry and Warwickshire NHS Trust, Coventry  &
Prof. Nithya Krishnan, Consultant Transplant Nephrologist, University Hospitals Coventry and Warwickshire NHS Trust and Professor, Centre of Health & Community Care, Coventry University.

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The National Kidney Federation cannot accept responsibility for information provided. The above is for guidance only. Patients are advised to seek further information from their own doctor.

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