Renal Transplant


A renal transplant is a surgical procedure to transplant a functioning kidney from a donor to a patient with end-stage renal failure (ESRF). The transplant can either be from a live or cadaveric donor.



Can be divided into:

Signs of current renal replacement:

  • Right Iliac fossa scar
  • Mass underneath – size, tender, percussion quality (dull) and consistency
  • Sometimes LIF scar with mass underneath – may be due to failure of old transplant

Signs of previous renal replacement:

  • AV fistula – palpate and auscultate for thrill to assess function and look for any recent venepuncture marks
  • Peritoneal catheter or scars from previous catheter sites
  • Scars on chest from previous tunnelled haemodialysis venous lines or central lines – these scars can be very subtle

Complications of ESRF:

  • Pallor suggesting anaemia
  • Parathyroidectomy scar from secondary or tertiary hyperparathyroidism

Side effects and complications of immunosuppressants:

  • Gum hypertrophy – ciclosporin
  • Hirsutism – ciclosporin
  • Hypertension – ciclosporin
  • Cushingoid features – steroids
  • Purpura – steroids
  • Evidence of skin malignancy – much more common with immunosuppressants


Clues as to aetiology:

  • Unilateral/bilateral palpable native kidneys – Polycystic kidney disease (PKD)
  • Nephrectomy scar or debulking scars ?kidney removal due to PKD
  • Hypertension
  • Fingerprick marks from CBG testing


Adequacy of renal replacement:

  • Fluid status
  • Signs of uraemia



The patient should have no symptoms if the transplant is functioning and they are tolerating immunosuppressants.

Symptoms that may indicate a failing transplant include tenderness over the transplant, fever, increased fluid retention, abdominal pain, and reduced urine output







Autosomal dominant polycystic kidney disease


Investigations prior to transplant:

Renal screen to assess for cause should have already been performed

Blood tests – routine bloods such as FBC/U+E/LFT/Coag screen/inflammatory markers

Viral serologies – Hepatitis/HIV/CMV

Group and save and cross match



Pulmonary function tests


In females – up to date cervical smear

Up to date dental check up




Patients reviewed routinely at specialist centre

Regular blood tests checking U+E/FBC/LFT

BP and cardiovascular risk monitored

Assessment of transplant function is performed

Assessment for side effects and complications of immunosuppressants

Women need regular cervical smear

Patients should wear a medic alert bracelet/necklace

Advice to contact doctor if they develop fever or prolonged illness

Annual influenza vaccination

Advice regarding smoking cessation and weight loss



Top tips:

To complete the renal transplant station say that you would want to dip urine and ask for BP. Always check the gums of a transplant patient in case they are on ciclosporin (an immunosuppressant which can cause gum hypertrophy). This looks very slick in the exam!


Written by Jo Corrado

Resources used to write this document are listed in the references section of this webpage