Do You Keep Your Own Kidneys After a Transplant?

Yes, usually. During a kidney transplant, the patient's own kidneys are normally left in place. The transplanted kidney is added in a different position rather than simply replacing one of the native kidneys.

It can sound surprising at first. If an organ has stopped working, it seems logical that surgeons would remove it before putting a new one in. Kidney transplantation works differently, and understanding why is useful for student nurses learning renal anatomy, transplantation and post-operative care.

Where are your own kidneys?

The native kidneys sit high in the posterior abdomen, one on either side of the spine. They are retroperitoneal organs, meaning they lie behind the peritoneum. Their normal position is very different from the position chosen for a transplanted kidney.

Where does the transplanted kidney go?

A transplanted kidney is usually placed in the lower abdomen, in the right or left iliac fossa, often described to patients as the groin area. This position gives the surgical team access to suitable blood vessels and allows the donor ureter to be connected to the bladder.

The donor renal artery and vein are surgically connected to recipient blood vessels in the iliac region. The exact operative technique can vary, so it is more accurate to think of these as connections to the recipient's iliac vessels rather than one fixed vessel in every transplant. The donor ureter is then implanted into the bladder, allowing urine from the transplanted kidney to drain into the urinary tract.

This means a person with two native kidneys who receives a single transplanted kidney may have three kidneys anatomically, although the native kidneys may have little or no useful renal function.

Why aren't the old kidneys routinely removed?

Removing a native kidney is an additional surgical procedure with its own risks. If the kidney is not causing a clinical problem, there is usually no reason to remove it simply because it no longer provides adequate renal function.

Leaving the native kidneys in place avoids unnecessary additional surgery. This is why native nephrectomy, the surgical removal of one or both original kidneys, is not a routine part of kidney transplantation.

When might a native kidney need to be removed?

There are situations in which removal may be considered before, during or after transplantation. The decision is individual and made by the specialist transplant team.

Examples include very enlarged kidneys that leave insufficient space for transplantation, long-standing or recurrent infection arising from the native kidneys, or an appearance suspicious for malignancy. Very large polycystic kidneys in autosomal dominant polycystic kidney disease are one example where native nephrectomy may sometimes be required.

The key point is that removal is performed for a clinical indication, not simply because the native kidney has failed.

What happens when the transplanted kidney is connected?

Once the vascular connections have been completed, blood flow is established through the transplanted kidney. Some transplanted kidneys begin functioning promptly, while others take longer.

Delayed graft function can occur, particularly following deceased-donor transplantation. In this situation the transplanted kidney does not initially provide sufficient function and temporary dialysis may be needed while the graft recovers. Delayed function does not automatically mean that the transplant has permanently failed.

What happens after transplantation?

A transplanted kidney is recognised by the recipient's immune system as coming from another person. Patients therefore require immunosuppressant medicines to reduce the risk of rejection. These medicines need to be taken consistently for as long as the functioning transplant requires them.

Follow-up by the transplant team includes monitoring kidney function and assessing for complications. Nursing care in the immediate post-operative period may include close observation of fluid balance, urine output, haemodynamic status, blood results, pain, the surgical wound and signs of complications, according to local transplant protocols.

What should a student nurse remember?

The important point is not simply that the patient may have three kidneys. It is understanding the altered anatomy.

Native kidneys: usually remain in their normal retroperitoneal position.

Transplanted kidney: usually sits much lower, in the right or left iliac fossa.

Blood supply: donor renal vessels are surgically connected to recipient vessels in the iliac region.

Urine drainage: the donor ureter is connected to the bladder.

Native nephrectomy: is not routine and is reserved for specific clinical indications.

Aftercare: graft function, fluid balance and complications require careful monitoring, and immunosuppression is central to preventing rejection.

The simple answer

Most people keep their own kidneys after a kidney transplant. The donated kidney is usually placed in the lower abdomen and connected to the recipient's blood vessels and bladder, while the native kidneys remain where they are unless there is a clinical reason to remove one or both.

So the phrase kidney transplant can be slightly misleading if you imagine one kidney being taken out and another put into exactly the same space. In most cases, the operation is better understood as adding a functioning donor kidney to the existing anatomy.

References and further reading

NHS Blood and Transplant (n.d.) Kidney transplant surgery. Available at: NHS Blood and Transplant.

NHS Blood and Transplant (n.d.) Kidney transplantation. Available at: NHS Blood and Transplant.

NHS Blood and Transplant (n.d.) Rejection of a transplanted kidney. Available at: NHS Blood and Transplant.

Leeds Teaching Hospitals NHS Trust (n.d.) Is kidney transplantation for you? Available at: Leeds Teaching Hospitals NHS Trust.