What Is a Kidney Transplant Specialist?

Kidney transplant specialists are doctors who specialize in the diagnosis, treatment, and preoperative, operative, and postoperative management of patients who undergo kidney transplant. To become a kidney transplant specialist, after graduating medical school, a doctor usually completes a residency program in urology or nephrology, followed by fellowship training in kidney transplant. Urologists who specialize in kidney/pancreas transplant are focused on the surgical aspect of the transplantation. Nephrologists who specialize in kidney transplant are focused on the medical management of renal transplant, including transplant immunology and pharmacotherapy, medical complications of transplantation, and graft dysfunction.

Kidney transplantation can become necessary in people with end-stage renal disease (ESRD) or complete renal failure, whether due to urinary infections, diabetes, hypertension, immune system disorders, kidney stones, kidney inflammation (glomerulonephritis), birth defects, drug overdose/intoxications, or genetic diseases.

Kidney transplantation specialists usually work within a multidisciplinary team that includes the transplant surgeon, anesthesiologist, transplant nephrologist, renal nutritionist, infectious disease specialist, social worker, and transplant coordinators.

2. When Should I See a Kidney Transplant Specialist?

Your nephrologist will usually refer a doctor for a kidney transplant specialist if you have ESRD and may benefit from renal replacement therapy. Symptoms that may indicate a serious kidney condition include:

• High blood pressure
• Abdominal pain
• Nausea or vomiting
• Abnormal volume of urine
• Shortness of breath
• Muscle weakness
• Fatigue and lethargy
• Swelling in legs or puffy face and eyes
• Loss of appetite

3. What Kind of Tests Does a Kidney Transplant Specialist Perform or Recommend?

Before kidney transplant is recommended, a complex evaluation is made, including the following factors that may determine whether you can be a candidate for transplantation:

• Renal function below a certain threshold
• Cause of the renal disease
• Presence of morbid obesity
• Compliance and adherence to current treatments and recommendations
• Substance abuse history
• Cardiovascular risk factors
• Presence of any current infection or malignancy (cancer)
• Infectious or immune disease history

If you become a kidney transplant candidate, you will likely be placed on a waiting list for a deceased donor kidney. Once a donor (living or deceased) is found, compatibility tests are necessary between the donor and you (the recipient), including:

• ABO compatibility (blood typing)
• Tissue typing (histocompatibility)
• Cross matching

If compatibility is confirmed, more tests may be necessary for a living donor, including:

• Physical evaluation, medical history, medication list
• ECG and cardiac evaluation to exclude cardiovascular disease
• Imaging tests including x-rays, ultrasound, and more
• Renal function tests
• Urologic evaluation to evaluate renal anatomy and exclude urinary tract infections, nephrolithiasis, and other urologic conditions
• Infectious disease markers
• Tests to exclude cancer (Pap test, mammogram, PSA, and others)
• Pregnancy test
• Tests to exclude diabetes

Your kidney transplant doctor or transplant team may request more tests after a successful transplant to check the proper functioning of your received kidney (the graft).

4. What Questions Should I Ask a Kidney Transplant Specialist?

You may want to these kinds of questions:

• What is the stage of my kidney disease? Are there any chances to recover my kidney function with conventional therapy?
• Can I continue with dialysis? For how long can my transplant be delayed?
• What are the potential side effects and risk factors involved with kidney transplant?
• Do I qualify for kidney transplant?
• How long will I need to wait for a donor?
• What if I am incompatible with my relatives who were tested as donors?
• How long do I need to stay in the hospital after the transplant?
• What are the possible complications after the procedure?
• How long will the transplanted kidney last? What precautions should I take in order to keep it working properly?
• When can I resume normal work and routine activities?
• How often do I need to follow-up?
• Do I need to take the medicines after the transplant? Till when? What are their side effects?
• What special diet do I need to follow after the transplant?
• What other lifestyle changes should I follow to avoid complications?
• What are the signs or symptoms of failed transplantation? What are signs and symptoms that indicate a medical emergency?
• Are my family members at risk of kidney disease?
• Are there any patient support groups for me or my family?