Transplant Surgery: Step-By-Step



For more details about the Transplant Evaluation and Process, visit the GW Transplant Institute.


Once a kidney becomes available, a transplant coordinator will notify you to be admitted to the hospital.

Once You Are Admitted

After you arrive, the transplant team will take a complete medical history and perform a physical exam. We will draw your blood, as well as perform a chest X-ray and an EKG. Depending on your lab results, you may need dialysis before surgery. The kidney transplant surgery will take about three or four hours. This is actual operating time and does not include time spent in the recovery room. Please tell your family and friends not to worry if you are in the operating room longer than this. Family and friends may wait in the surgery waiting area, where they will get frequent updates. Your transplant surgeon will meet with them to tell them how you are doing while you are in the recovery room.

In the Operating Room

Before you go into the operating room, you will be asked to remove your clothes and put on a hospital gown. The transplant team will start an intravenous (IV) line in your arm or hand. The IV will deliver fluids and medications during your surgery.

The team will insert a catheter into your bladder to collect urine as your new kidney starts working.

The team will insert a tube into your mouth that allows us to connect you to a machine that will help you breathe while under anesthesia.

We may need to shave hair off of your abdomen to prevent infections. We will clean your abdomen with a special solution before the surgeon makes the incision.

Your surgeon will make the incision to implant the new kidney. Once your surgeon connects the kidney to your veins, arteries and bladder, the surgeon will close the incision with staples or stitches. We may use a dressing bandage to protect the surgical site.

Unless your native kidneys are causing a problem, they will remain in your body. This is because the surgery to remove your own kidneys would be greater than the surgery to implant a new kidney.

After Surgery

You will go to the recovery area after surgery, and stay there until you are easily awakened and able to talk with the nurses. You may feel some discomfort and/or nausea when you wake up. The pump connected to your IV will allow you to self-administer pain medications at set times.

After surgery, we may admit you to the intensive care unit (ICU) for the first 24 hours to make sure your vital signs are stable and your new kidney is working well. As soon as you are stable, we will transfer you to a unit with nurses who are trained to care for transplant recipients.

This specialized care will focus on:

Pain Management
On a scale of one to 10, with 10 being the worst, we like to keep your pain score at three or less. Most patients will manage their pain with the special IV medication pump.

You will start taking medications to lower your risk of kidney rejection. Your nurses and a pharmacist will tell you about each medication. Before you leave the hospital, you will be taking these medications yourself with the nurse assisting and guiding you.

Balancing your immune system with medications
The GW Transplant Team will monitor your medications to make sure that we have a dose that is the right balance for you. To do this, we will draw your blood levels every week after we discharge you from the hospital.

If we suppress your immune system too much, you are at a higher risk of infection. If we don’t suppress your immune system enough, you are at a higher risk of rejecting your new kidney. This is why it is important that you take your medications exactly as prescribed and at the times stated on your medication form.

Preventing Pneumonia
To prevent pneumonia, we will ask you to:

  • Frequently cough and breathe deeply
  • Use the small breathing machine at your bedside to move air in and out of your lungs
  • Get out of bed and sit in a chair
  • Walk in your room as soon as possible to help prevent complications after surgery

Length of Hospital Stay
Most patients stay in the hospital for three to six days after kidney transplantation. We will work with you and your family to prepare you to go home.

Leaving the Hospital: Discharge

After you leave the hospital, you will return to the GW Transplant Institute clinic one to two times a week for the first few weeks after your transplant. We will:

  • Evaluate you at each visit to make sure you are progressing well
  • Draw blood to check how your new kidney is working and to see if your medication level is good enough to prevent rejection
  • Check your vital signs
  • Answer any questions you may have

Staying Healthy After Transplantation

We will monitor you closely at our clinic for the first three months after you leave the hospital. After that, you will return to your primary nephrologist (kidney doctor) or your primary care doctor. The GW Transplant Institute will test your blood on a schedule and receive your results. We will work with your nephrologist or primary care doctor to manage your transplant health and the health of your new kidney.

In order to stay healthy, follow these tips:

Diet and exercise: With good kidney function, you should be able to return to a more normal diet. We expect you to exercise every day to keep your weight in a healthy range.

Self-monitoring: You will keep track of your own vital signs every day. This includes blood pressure, pulse and temperature. You will also keep track of your weight. Bring these records to the clinic with each visit so that we can see how you are doing at home.

Sunscreen: Transplant recipients have a much higher skin cancer risk than the general population. It is important to put sunscreen on before you go outside. Wear clothes that cover most of your body when you are outside. A regular checkup with a dermatologist (skin doctor) is a very good idea.

Dental Health: Keep up with your dental exams and cleanings. Tell your dentist that you had a kidney transplant. You do not need an antibiotic for cleanings, but if you have a tooth pulled, you should consider an antibiotic.

Please note: Do not take your medications prior to coming to each clinic because we want to test the level of immunosuppression in your blood. If you take the immunosuppressive drugs, your level will be very high and will not tell us what we need to know about dosing your medications.