The field of organ transplantation is complex. While the entire Transplantation Team is readily available to you to answer all your questions, the following information will help you understand the process and procedure related to transplantation.

Kidney and Pancreas Transplantation

General information

There are many organizations that provide useful information for individuals with diabetes or kidney disease who are considering organ transplantation, including:

Transplant Living

United Network for Organ Sharing

The Sharing Network

National Kidney Foundation

American Association of Kidney Patients (AAKP)

American Diabetes Association

American Society of Transplant Surgeons

Glossary of terms

The following list will help you become familiar with some terminology related to transplantation.

ABO: A red blood cell test that determines blood type. This test determines which red blood cell types are compatible between a recipient and donor. People are identified as Type A, B, AB, or O. Type O is the most common, followed by Type A.

Absorption: The degree and speed at which a drug enters the blood stream.

Acute Renal Failure: See RENAL FAILURE, ACUTE

Acute Tubular Necrosis (ATN): Reversible kidney damage resulting in delayed kidney function. Can be caused by medications to prevent rejection or more commonly by prolonged cold storage of the kidney prior to transplantation.

Anemia: A condition in which the blood has a lower than normal amount of red blood cells

Anesthesia: Medication given by a highly-skilled physician or nurse which results in a sleep and relaxation state in order to perform a medical procedure without pain. "Local" anesthesia numbs a specific area; while "General" anesthesia puts the patient to sleep.

Angiogram (Arteriogram): Specific X-ray picture of blood vessels. A renal arteriogram is performed by using local anesthesia then injecting a small amount of contrast dye into the femoral artery in the groin. This allows visualization of renal anatomy, blood supply, and any abnormalities.

Antibody: A protein made by the body's immune system in response to a foreign substance such as a blood transfusion, pregnancy or previous transplant. Because the antibodies can attack the transplanted organ, transplant recipients must take immunosuppressive medication to ward off rejection of the organ.

Antibody Screen: A blood test that determines what percent of antibodies (formed by their immune system) a potential recipient has formed against a potential donor. This test is also known as an antibody titer or PRA (Percent Reactive Antibody). People with a level of 50 percent or higher are considered to have a high antibody level.

Antigen: A molecule or substance that is seen by the body as foreign, such as a transplanted organ, that triggers a response from the immune system. This response may be due to increased production of circulating antibodies.

Anti-Thymocyte Globulin (ATG): An immunosuppressive medication used after transplantation to prevent and or treat acute rejection.

Artherosclerosis: The disease in which plaque builds up in the inner walls of the arteries, causing narrowing or blockage. Commonly known as “hardening of the arteries.”

B Cell: A specialized white blood cell responsible for the body's immunity. B cells play a central role in antibody production.

Bilateral: On both sides.

Biopsy: Taking a sample of tissue to examine under a microscope for the purpose of making a diagnosis.

Bladder: The part of the urinary tract that receives urine from the kidneys and stores it until urination.

Blood Type: See ABO.

Brain Death: When the brain has permanently stopped working, as determined by physical examination and appropriate confirmatory testing. Donor organs can only be recovered from persons declared legally dead.

BUN: Blood urea nitrogen, a waste product normally excreted by the kidneys.

Cadaver: The body of a person who has died.

Cellcept: An immunosuppressive medication used after transplantation to prevent rejection. Its generic name is Mycophenolate Mofetil.

CMV (Cytomegalovirus): A virus that lies dormant in the body and can be transmitted or reactivated after transplantation.

Contraindication: Any procedure that would not be in a person's best interest to be undertaken. By means of physical and psychological examination, physicians and healthcare team members are careful to identify any contraindication to kidney transplantation.

Corticosteroids: Hormones secreted by the adrenal gland; can also be manufactured. In high doses, corticosteroids cause Immunosuppression.

Creatinine: By-product of muscle breakdown that is normally removed from the blood by the kidneys. A normal blood level of creatinine is 0.9- 1.3 mgm percent. When the blood level of creatinine is elevated, this can mean abnormal kidney function.

Chronic Renal Failure: See RENAL FAILURE, CHRONIC

Crossmatch: The test used to determine if a potential recipient makes an antibody response against a potential donor's antigens. A POSITIVE crossmatch means a reaction occurred and shows the recipient has made antibodies against that particular donor, making the donor and recipient incompatible. A NEGATIVE crossmatch means there was no reaction and the transplant may proceed.

Cyclosporine A: An immunosuppressive medication used after transplantation to prevent rejection. This medication comes in two formulations but they are NOT interchangeable. The trade names include Sandimmune or Neoral and Gengraf.

Cystoscopy: A procedure in which an instrument placed through the urethra and into the bladder is used to see the inside of the bladder and to remove stents.

Deceased Donor (formerly called cadaveric donor):  A deceased donor is a recently deceased individual whose family has agreed to donate his/her organs and or tissue for transplantation.

Diabetes: A disease in which the blood sugar is persistently elevated. This may be the results of the loss of insulin production by the pancreas or by the inability of the body to appropriately respond to the insulin.

Dialysis: The process of cleansing and achieving chemical and fluid balance in the blood of patients whose kidneys have failed.

Donor: The person who gives an organ to somebody else.

Endotracheal Tube: An airway tube inserted through the mouth leading to your windpipe to help you breathe during surgery.

Electrocardiogram (EKG or ECG): A tracing of the electrical rhythm of the heart. The tracing is done by placing EKG leads on the arms, legs, and chest. This does not cause any discomfort. A picture that is displayed helps determine any current or past cardiac problems.

ESRD (End Stage Renal Disease): A condition for which patients need dialysis or a transplant to survive.

FK506: See Tacrolimus.

Foley Catheter: Brand name of the tube that is placed into the bladder to drain urine.

Hematocrit: A measure of the percent of red blood cells in the blood.

Homodialysis: See Dialysis

Human Leukocyte Anitgens (HLA): The system for determining and identifying a person's genetic antigen makeup. There are three major classifications: HLA- A, B, and DR. Each person inherits one half of their HLA make up from each parent; therefore, testing will identify 2 HLA A antigens, 2 B antigens and 2 DR antigens for a total of 6 antigens. In transplantation the HLA (tissue type) match between the recipient and the donor are very important.

Hypertension: Another name for high blood pressure. Hypertension can damage the body by overworking the heart and blood vessels.

Immune System: The body system that serves as a defense mechanism and protects the body by fighting against foreign intruders into the body. These intruders include bacteria, viruses and foreign cells in the form of organ transplants. Antibodies may be formed against these foreign substances.

Immunosuppressant Medications: Medications given to lessen the action of the immune system.

IVP:  X-ray picture of the kidneys that shows size, placement and the drainage system, performed by injecting contrast dye into a small vein of the arm, then performing an X-ray. It can also be performed by CT (CAT) scan.

Kidney: One of two organs located under the rib cage on each side of the spine. Their function is to regulate the chemical and fluid balance of the body. If the kidney fails, dialysis or transplantation is required to remain alive.

Laparoscopic: Method of performing surgery by using instruments called laparoscopes. The laparoscope is a long "tube-like" instrument less than 1" in width.

Medicare: Government provided medical insurance that was begun under the Social Security Act. It covers most patients with chronic renal failure and covers the costs of transplantation for the donor and the recipient.

Neoral: An immunosuppressive medication used after transplantation to prevent rejection. Its generic name is cyclosporine A. Neoral is an emulsion and more readily absorbed by the body and thus therapeutic blood levels are reached more quickly.

Nephrectomy: Surgical removal of the kidney from the body.

Nephrologist: Medical physician highly-skilled in the function and disease of the kidneys.

Nephron: A section of the kidney composed of millions of tiny blood-filtering tubes.

Noncompliance: Failure to follow the instructions of one’s health care providers, such as not taking medicine as prescribed or not coming for scheduled doctor’s appointments.

Organ Preservation: Immediately upon recovery from a donor, organs/tissues are placed in “preservation fluid” until just before they are ready to be transplanted into the recipient. The length of time an organ can be preserved outside the body varies by organ. The goal is to transplant organ with the shortest preservation time possible.

Pancreas: An organ with two functions. It controls blood sugar (glucose) by releasing hormones such as insulin into the blood. It also produces enzymes to help digest food. Diseases of the pancreas can result in Diabetes.

PCA (Patient Controlled Analgesia): Computerized pump attached to the patient’s IV. It provides medication that allows the patient to give pre-determined doses of pain medication at regular intervals.

PRA (Panel Reactive Antibody): See ANTIBODY SCREEN.

Prednisone: An immunosuppressive medication used post-transplant to prevent and rejection. See corticosteroids.

Prograf: See Tacrolimus.

Rapamycin: See Sirolimus.

Rejection: When the body recognizes the new kidney is a foreign tissue and attacks it by making an immune response. A rejection episode does not mean the transplanted kidney will be irreversibly rejected; most rejection episodes are reversed with medications. The transplant recipient will need to take immunosuppressive medications for life to prevent rejection of the organ.

Renal: Another name for kidney.

Renal Failure, Acute: Kidneys may stop working temporarily due to a variety of conditions or diseases. It usually comes on quickly over a period of hours or days. Dialysis is sometimes necessary during this time. The kidneys usually regain their function when the underlying condition is reversed.

Renal Failure, Chronic: This is also known as End Stage Renal Disease. Unlike acute renal failure, the kidneys have been slowly losing function over a long period of time, usually months or years. They do not regain function and patients will require either long-term dialysis or transplantation.

Renal Scan: A procedure used to determine how well the transplanted kidney is working. An injection of dye is given into a vein. The flow of dye is followed by the scanner that translates the findings onto an X-ray film.

Routine Required Request: This Federal law requires all hospitals to tell families of suitable donors that their loved one’s organs and tissues can be used for transplantation and offer the families the opportunity to consent to organ donation.

Sandimmune: An immunosuppressive medication used after transplantation to prevent rejection. Its generic name is cyclosporine A. Sandimmune is oil based and more slowly absorbed by the body and thus therapeutic blood levels are reached more slowly.

Sensitization: The transplant candidate has blood tested each month against a panel of proteins to detect the presence of pre-formed antibodies to these proteins. The number of proteins the candidate reacts against is expressed as “percent reactive antibody” or “percent sensitized.” A candidate who reacts to less than 10% of the panel is considered to be Unsensitized; those candidates who react to more than 10% of the panel are considered to be Sensitized. See ANTIBODY SCREEN.

Sirolimus: An immunosuppressive medication used after transplantation to prevent rejection. Trade name is Rapamycin.

Spiral CT (Spiral CAT Scan): See IVP. Test is performed in the same way; however, it provides a more detailed 3-D anatomic picture of the kidneys and blood vessels.

Stenosis: Another word for narrowing.

Stent: Small tube placed in the ureter during surgery to protect stitches and promote healing. Must be removed six weeks after surgery by cystoscopy.

T Cell: A white blood cell responsible for the body’s immunity. T-Cells can recognize and destroy cells infected by viruses graft cells and other foreign cells.

Tacrolimus: An immunosuppressive medication used after transplantation to prevent rejection. Trade name is Prograf, previously known as FK506.

Tissue Typing: See HLA. Blood test to determine the degree of match between an organ donor and recipient. Done pre-transplant.

Transplant: The process of surgically placing an organ from one person into another person.

Transplant Coordinator:  A Registered Nurse with advanced training in the care and needs of patients in need of an organ transplant. Coordinates the process of the transplant evaluation, all necessary testing, and listing for a deceased donor organ, as well as evaluation for any potential living donors. After the transplant, provides a communication link between the recipient and the transplant doctors for post-transplant care.

Ultrasound: A procedure used to determine how well the transplanted kidney is working. Performed in the Radiology Department. An instrument is moved along the skin over the kidney that shows the kidney. The image is transferred to an X- ray film.

Uremia: Condition when the kidney cannot clear the toxins normally excreted in the urine.

Unilateral: On one side.

Ureter: One of the tubes that carries urine from the kidneys to the bladder.

Urethra: The tube from the bladder through which urine flows out of the body.

close (X)