What are the Risks of Kidney Transplant Surgery?

Comparing Long-Term Outcomes of Transplant vs. Dialysis

There are several ways of looking at the risks associated with kidney transplantation. While transplant surgery has risks, these need to be measured against one’s quality of life without transplant and/or relying on dialysis long-term.

Overall, two to four people out of 100 (2% to 4%) will die in the first year after a kidney transplant. In comparison, the risk of death is twice as high for patients who continue on dialysis while waiting for a kidney transplant.

Transplant Surgery and Outcomes

A kidney transplant starts with general anesthesia, which has become much safer over the years. In 1950, the risk of dying from anesthesia was 1 in 1,500; today, it has dropped to 1 in 250,000 cases. It is extremely rare for a patient to die during transplant surgery. If it occurs, it would likely be a complication of anesthesia rather than the surgery itself.

The most common causes of death in the years following transplantation include:

• Heart disease


• Infection


• Cancer


• Other causes

The Kidney Team tries to reduce these risks, both before and after transplant. For example, by requesting a series of heart tests to identify problems prior to transplant, the Team tries to reduce a patient’s heart attack risk. Addressing issues such as smoking and high blood pressure will also reduce one’s risk of heart attack post-transplant. Infection and cancer risk following transplantation are related to anti-rejection medications. Normally, the immune system helps to reduce one’s cancer risk and prevents infections by destroying any precancerous cells or invading organisms. In order to reduce the risk of infection following a kidney transplant, patients are kept on antibiotics for several months.

It is important to lower your risk factors for cancer by limiting sun exposure and not smoking. The Kidney Team also recommends routine health screenings, including mammograms, Pap smears, prostate antigen checks (PSA) and colonoscopies.

Factors Affecting Mortality

Transplant patients with vascular disease, who are older (above 60), obese, smoke, or have preexisting heart disease face increased mortality. Patients with systemic illnesses like diabetes and hypertension also have a higher mortality. A reduced mortality rate is seen among transplant patients with primary kidney diseases such as glomerulonephritis and polycystic renal disease who are otherwise healthy. The five-year survival of diabetic patients with a transplant is 75% to 80%, while it is only about 30% with dialysis. Unfortunately, there is no perfect treatment for kidney failure because each choice that a patient makes carries its own set of risks.

Kidney Donor Source Affects Survival

The source of one’s kidney donor affects survival following kidney transplantation. Patients with a living donor have the best survival overall, compared with patients who receive a deceased donor kidney transplant. The one- and five-year survival of patients who receive a living donor transplant are 98% and 90% respectively, whereas with a deceased donor transplant, they are 95% and 81% (see line chart). This is one reason the Kidney Team encourages all patients to see if a family member or friend may be willing to donate a kidney. Not only is the survival better following kidney transplantation, but by avoiding dialysis and receiving a transplant sooner, patients are able to avoid the risk of long-term dialysis. The greatest success among patients receiving a transplant is seen in patients receiving their transplant before ever starting dialysis.


Read more about kidney transplant surgery.



Line Chart of Kidney Transplant Survival
1-year: Living Donor=98% Survival, Deceased Donor=95% Survival; 5-year: Living Donor=90% Survival, Deceased Donor=81% Survival

article published in October 2005 Kidney Review newsletter

About California Pacific Medical Center

California Pacific Medical Center, part of the Sutter Health network, offers kidney, pancreas, liver and heart transplantation as part of our Barry S. Levin, MD Department of Transplant.

Kidney & Pancreas Transplant Program
California Pacific Medical Center
2340 Clay Street
San Francisco, CA 94115
Tel. 415-600-1700

Outreach locations available throughout Northern California and in Reno.