Kidney transplant: Surgical and post-operative complications

PDF download is not available for Arabic and Urdu languages at this time. Please use the browser print function instead

Teen girl with stomach cramps

Surgical complications are any problems with your new organ that are related to the surgery. Some of these problems show up a day or two after your transplant. Post-operative complications are problems that appear a few weeks or a few months later.

Surgical and post-operative complications include:

Delayed graft function

Your transplant organ is sometimes called a graft. Delayed graft function happens if the kidney does not start working right away. The medical name for this is acute tubular necrosis (ATN).

Usually, the new kidney just needs time to fix itself. However, if there is a serious delay, you may need dialysis until your kidney starts to work properly. Waiting for your new kidney to work can be hard; it might start up in as little as a few hours or as much as a few weeks.

Primary non-function

In very rare situations, the kidney never starts working and must be removed. Your transplant team will do many things to prevent this from happening. For example, an ultrasound is often done in the operating room right after the surgery to make sure that enough blood is getting to the kidney. If anything unusual appears at that time, the surgeon will immediately try to fix the problem.


Blood carries oxygen around the body through blood vessels. Thrombosis occurs when a blood vessel has a clot, or blockage. Blood clots can build up in the vessels in or around the new kidney and stop blood from reaching it. In rare cases, the clot can prevent enough oxygen from getting to the kidney. This could cause the kidney to die.

Clotting is more common in younger children, but it can also affect teens. If you have any clotting, your transplant team will give you medicines that treat clots and prevent more from developing.

Fluid collections

Sometimes fluid can collect and build up to block the flow of urine through the kidney and from the kidney down to the bladder. The fluid may be:

  • lymph
  • urine
  • blood.


Lymph fluid is called a “lymphocele”. If there is only a small collection, it will not harm your kidney and your body will eventually re-absorb it. If there is more fluid and it is affecting the function of your kidney, it may need to be drained with a small tube.

It can take a while to get rid of this fluid because it can come back even after it is drained. Getting rid of excess lymph fluid often means extra ultrasounds and trips to the hospital. Sometimes only surgery can fix the problem.


A collection of urine in your body is called a urine leak. This can happen when urine leaks out from your ureter (the tube that connects your new kidney to your bladder).

Some surgeons try to prevent a urine leak by putting a stent (a small plastic tube) inside the ureter when they are placing your new kidney. If a stent is put in at the time of surgery, your surgeon will remove it about six weeks later.

If you have a urine leak, you will likely need to keep your urinary catheter in for longer to reduce the pressure on your bladder. You will also need to limit your physical activity until this leak heals.


A collection of blood is called a hematoma. Blood can collect when there is some bleeding and the blood forms a clot around or beside the kidney. Most of the time, no treatment is needed because your body slowly re-absorbs the blood.


In the first weeks after transplant, you might have a seizure. This can happen because:

  • your blood pressure gets too high
  • there is too much fluid in your body
  • the new kidney works so fast that it cleans the blood before your brain can adjust to the new levels of urea, electrolytes and other substances
  • you have too much anti-rejection medication (tacrolimus or cyclosporine) in your system.

Your transplant team will give you medicines to control the seizures if you need them.

Blood problems that require a blood transfusion

Anemia is a common condition that occurs you have lower than normal levels of healthy red blood cells (hemoglobin). This can happen before your transplant because of your chronic kidney disease or end-stage renal disease.

Blood loss during surgery or delayed function of your new kidney may make anemia worse. Some of the medicines needed after transplant can also affect your red blood cells.

When you lose too much blood, you need a transfusion (donation of another person’s blood) to replace it. Depending on the amount of blood you lose during your surgery, you may need blood transfusions in the operating room.

You might sometimes need blood transfusions after your operation to treat anemia until your body is able to correct the levels of red blood cells on its own.

Sometimes the transplant team will treat the anemia with medicine that helps to increase your red blood cells.​

Last updated: November 30th 2017