Complications problems after surgery

It is common after surgery to have some complications, or problems. Some problems are easily treated and others are more severe.

The following are the most common problems after kidney transplant.

Problems from surgery

  • reaction to anesthesia
  • infection
  • bleeding.

Acute tubular necrosis (delay in new kidney working) 

Your kidney may not work right away after surgery. This delay is called acute tubular necrosis. The new kidney goes through a "shock" during the removal and transplant.

The delay may last two to four weeks after surgery, but it can last for months. Usually most transplanted kidneys will start making urine and start working well.

While your kidney is not working, you may need to be on dialysis. Your social worker will schedule your dialysis, as ordered by your transplant nephrologist (kidney doctor).

In addition, your nephrologist will want to take small samples of the kidney (a procedure called a biopsy). This is the best way for your doctors to know what is happening with the kidney.


Rejection is your body's natural response to a foreign object. Even though you and the kidney donor were a match, your body may react to the new kidney.

Most rejection episodes occur within the first couple of months after surgery. But, rejection may happen at any time - even more than 10 years after surgery. This is why you will need to take anti-rejection medicine for the rest of your life.

There are a number of types of rejection. Some respond to medicine and others do not. Having a rejection does not always mean you will lose the kidney and be back on dialysis. 

If the rejection is caught early, in most cases it can be treated. If your nephrologist thinks you may be having a rejection, you may have a kidney biopsy. (You do not need to stay in the hospital to have a biopsy.)

All follow-up visits and lab checks are important.

Please keep any appointment, no matter how you feel. If your body is rejecting the kidney, the first signs may show up in the lab results. By the time you "feel sick," the rejection may have caused the kidney to fail.


The anti-rejection medicines you need to take for the health of your new kidney lower your body's ability to fight infection. You are at the greatest risk for infection the first two to three months after surgery or after any rejection episode. This is when the anti-rejection medicines are at their strongest doses.

There are three types of infection: bacterial, fungal and viral. You will take two medicines to prevent many bacterial and fungal infections.

A common viral infection after surgery is caused by the cytomegalovirus (CMV). Infection usually occurs one to three months after surgery but it can occur at any time. CMV ranges from mild to severe.

Important: Even if you think you might have signs of infection, call your transplant team right away.

Increased blood glucose

Your blood glucose levels may rise after surgery. This usually occurs right after surgery or if you are being treated for a rejection episode. This happens because the steroid medicines you are taking are at their highest doses.

You may need to take medicine to lower your blood glucose (such as insulin).

The rise in blood glucose may not last long or it may continue even after the strength your anti-rejection medicines are decreased.

If you are older, have a family history of diabetes or if you have a history of higher blood glucose, you are at an increased risk. 


A lymphocele is a collection of lymph fluid around your kidney. These are seen the first couple of months after surgery. Usually, the lymphoceles are small. In time, your body will reabsorb the fluid and treatment is not needed.

If the lymphocele becomes large and presses on the kidney, you can feel discomfort and/or have decreased kidney function.

The fluid can leak along your surgery incision. If this happens, you may need surgery to drain the fluid or have drainage tubes put in place. (Tubes are usually removed in a couple weeks.)

High blood pressure

High blood pressure (hypertension) is a common problem after surgery. Many of the anti-rejection medicines cause blood pressure to rise. As the strength of those medicines decrease, your blood pressure usually decreases.

You may need to take medicine to control your blood pressure.

Clotting problems

Clots may also form in the deep veins in your legs. These clots are known as deep vein thrombosis, or DVT. They occur right after surgery when you are not able to get any physical activity. Symptoms of DVT include:

  • swelling
  • tenderness
  • warmth.

To help prevent DVT, you will be:

  • wearing TED ® stockings to help the blood circulate in your legs
  • wearing a sequential compression device/Plexi-Pulse ® machine (leggings and foot wraps) to help prevent blood clots
  • given heparin, a medicine to keep your blood from clotting
  • walking as soon as possible. 

Hyperlipidemia (increase of fats in your blood)

Hyperlipidemia is an increase of the amount of cholesterol and triglycerides in your blood. An increase of these fats can lead to heart disease.

Hyperlipidemia has no symptoms. The only way your doctor can tell if you have it is by doing a lipid test. This test measures the amount of total cholesterol, LDL (bad) cholesterol, HDL (good) cholesterol and triglycerides.

You can manage hyperlipidemia with a lowfat diet, weight control, regular exercise and/or medicines to lower your cholesterol. You and your doctor can decide if medicines are right for you.

Source: Allina Health Patient Education, Kidney Transplant Information for Recipients and Donors, renal_ahc_93498
Reviewed By: Allina Patient Education experts, including the Transplantation Department of Abbott Northwestern Hospital
First Published: 05/15/2009
Last Reviewed: 05/15/2009

  • Some problems may cause you to stay in the hospital longer than you expected. Your health care team will tell you what is happening. The transplant coordinator or the social worker will make arrangements for you.
  • Acute tubular necrosis is common in deceased donor transplants but can also happen with living donor transplants.
  • If you have symptoms of deep vein thrombosis, tell your doctor right away. You will need to stay in the hospital and have treatment.
Warning signs of rejection
  • fever of more than 100.5 F
  • feeling like you have the flu (chills, aches, tiredness, headache, dizziness, nausea or vomiting)
  • pain or tenderness over the new kidney
  • fluid retention (swelling) and sudden weight gain
  • pain or burning when urinating: discolored, bloody or foul-smelling urine; sudden increase in blood pressure.
Warning signs of infection
  • fever of more than 100.5 F
  • feeling like you have the flu (chills, aches, tiredness, headache, dizziness, nausea or vomiting)
  • cough or shortness of breath
  • sore throat
  • diarrhea
  • pain or burning when you urinate or feel like you need to urinate often
  • drainage from a skin wound or a wound/sore that won't heal or looks red or feels warm to the touch
  • feeling that you just don't feel "normal."