bowel function (have a bowel movement), adequate pain control with oral medications, financial and social support for taking all prescribed medications, good blood pressure control, and acceptable laboratory studies. Complications After Kidney Transplantation Kidney transplantation is generally a safe procedure with one-year patient survival rates greater than 95%. Given the co-morbid conditions from which renal failure patients suffer, these good outcomes cannot be assumed; complications do happen, even in apparently healthy recipients. Common Complications Pain: Almost all recipients of renal transplants will experience postoperative pain. Patients will receive a combination of intravenous and oral pain medicine after transplantation, and almost all patients will continue to require some amount of oral pain medicine after discharge from the hospital, but usually only for 1-2 weeks. Gastrointestinal problems: This complication is manifested commonly as nausea and constipation; vomiting is much less common. Bowel rest, anti-emetics, and time will help restore bowel function. Upon return of bowel movements, bouts of diarrhea are not uncommon. Diarrhea is often a side effect of the immunosuppressive medications, especially mycophenolate mofetil. Provided infectious sources are excluded, diarrhea can be controlled with anti-diarrheal medications. Delayed Graft Function (DGF): Approximately 30% of deceased donors and 2-4% of living donor renal transplant recipients will require dialysis in the first 7 days after transplantation. DGF does not dramatically impact the long-term function of the transplant, however, careful medical management is important as the kidney recovers function. Acute Rejection: Approximately 10-20% of kidney transplant recipients will experience acute rejection in the first post-transplant year. Acute rejection may be asymptomatic, or patients may experience fever and/or pain over the transplant. If acute rejection is suspected a transplant biopsy is necessary. Social and Medication Access Challenges: The sudden nature of the call for transplantation may make it harder for the patient to adjust to their new situation and to get their medications, including the prophylactic antibiotics and immunosuppressive medications which can be very expensive. The patient’s social support, such as their family, must also suddenly adjust their lives to help care for the patient. In addition, in the first year, the knowledge that someone died to give them a kidney may commonly lead to depression. Exacerbations of Co-morbid Conditions, Especially Cardiac Events and Diabetes: Up to 30% of kidney transplant recipients can newly develop diabetes after transplant due to the side effects of immune suppressive medications. These medications can also cause hyperlipidemia and hypertension, [KIDNEY TRANSPLANT TOOLKIT] May 13, 2019 © Copyright, Forum of ESRD Networks, 2019 Page 14 which must be treated. Also, the risk of myocardial infarction and congestive heart failure are higher in the months following renal transplantation. Infectious Complications: Infections happens more commonly after transplantation, in the setting of immunosuppression. Re-activation of cytomegalovirus (CMV), pneumonia from Pneumocystis and other opportunistic infections are a risk, prompting most centers to prophylactically treat patients with antimicrobial medications post-transplant, usually for a period of 3-6 months. The risk of bladder infection is approximately 10%. Skin infection and surgical site infections can also occur. Less Common Complications Vascular problems: Recipients may experience hemorrhage around and/or clotting involving the transplant kidney. These problems often require prompt re-operation and blood transfusions. Patients with a known hypercoagulable state will require anticoagulation during surgery. A thrombosed kidney that cannot be salvaged will be removed. Patients who lose their transplants in the immediate postoperative period will maintain their original place on the waiting list, if they recover well and are still an acceptable candidate for transplant. Malignancy: Transplant recipients are at increased risk for cancer when taking immunosuppression. The risk of cancer is slightly greater than the general population. Non-melanoma skin cancer, such as squamous cell or basal cell carcinoma, are common. Transplant patients should have regular screening examinations by a dermatologist. Lymphoma occurs in about 2% of kidney transplant patients. However, any other cancer can happen, necessitating regular surveillance. It is recommended that national cancer screening guidelines be followed. [KIDNEY TRANSPLANT TOOLKIT] May 13, 2019 © Copyright, Forum of ESRD Networks, 2019 Page 15 Chapter 3: Living Kidney Donation Author: Sumit Mohan, MD, MPH Approximately one third of kidneys that are transplanted in the United States today are from living donors and include both donors who are related and unrelated to the transplant recipient.i In 2015, 5626 living donor kidney transplants were performed in the United States. While this was a slight improvement over 2014, living donation rates remain below the peak of 6647 transplant performed in 2004 – despite a rapidly growing number of people waitlisted for kidneys. Figure 1: Number of kidney