Renal Transplant Surgery

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A kidney transplant is a surgical procedure to place a functioning kidney from a donor into a person whose kidneys no longer function properly. The transplanted kidney performs all the functions which the patient’s own kidney is not able to perform. The critical factor is that the donor and recipient tissues should match. 

Getting admitted to the hospital for transplant.

Living donor transplants are planned in advance. Patients and donors are admitted to the hospital one or several days prior to surgery depending on the advice of the surgical team. Both donors and recipients must not eat or drink anything after midnight before the operation.

Deceased donor transplants

Deceased donor transplants are performed on emergency basis when a cadaveric kidney is available. Patients are called to the hospital urgently; they undergo a rapid review and tests before surgery to ensure that they are healthy and ready for surgery. Patients should not eat or drink anything once they receive intimation for the transplant.

After the patients are admitted, the transplant team has a discussion about the quality of organ and transplantation process and asks the patient to sign the consent form after complete understanding of the process. Patients should inform the transplant team about pre-existing health problems, current medicines and known drug allergies, to prevent any accidental use and interaction with transplant medicines. If patients develop new unexpected problems such as fever and review tests show significant change compared to previous reports or if any new concerns or active problems are discovered, they might need treatment first and the transplant might have to be postponed.

The operation

The timings of donor and recipient surgeries are synchronized to ensure minimal ischemia to the donor kidney. Both donors and recipients undergo the operation under general anaesthesia, where they are put to sleep, with no consciousness, pain, awareness or recollection of the operation. While under anaesthesia, they are put on a ventilator and various lines / catheters (arterial line, central line, endotracheal tube, urinary catheter, naso-gastric tube, etc,) are used to accurately monitor various parameters and allow rapid administration of blood products, IV fluids and drugs. During the surgery, various blood and other tests are continuously performed for monitoring. 

Donor operation

What happens during donor surgery?

Kidney donation is a major surgery and is done under general anaesthesia. The living donor operation involves removal of a kidney and may be done using the conventional open method or the keyhole laparoscopic method. The open method is done through an incision on one side of the torso. The surgery takes 2 to 3 hours. 

The surgeon makes an incision about 15 to 20 cms long in the side of the abdomen. If the keyhole method is followed, the incision will be multiple and 1-3 cms each. The incision is closed using very fine absorbable sutures or staples.

After surgery, medications are given to alleviate the pain. For the first one or two days after surgery, the donor receives only intravenous fluids. Most donors are discharged by the fifth postoperative day.

What is laparoscopic donor nephrectomy?

This is a keyhole method for removing a donor kidney, using a laparoscope. It is a less invasive method and helps speedy recovery when compared to the conventional open method of surgery. Two or three small puncture incisions are made in the abdomen and keyhole instruments used in the surgery are passed through these incisions. 

Keyhole surgery takes longer to perform but recovery is faster.

Recipient operation

The recipient surgery generally takes 2-4 hours and sometimes blood transfusion may be necessary. However, the surgical team may decide to keep two to three units of blood on standby. 

Renal transplant surgery is a heterotopic transplant, which means the donor kidney is placed a different location than the existing kidneys. The kidney is placed in the front part of the lower abdomen, in the pelvis. The original kidneys are usually not removed unless they are causing uncontrolled blood pressure, frequent kidney infections or greatly enlarged.

First a cut is made in the lower abdomen through which the donor kidney is put in place. The recipient’s kidneys will remain and will only be removed if there is infection.

The second step involves attaching the blood vessels of the donor kidney to the blood vessels near the recipient kidney to establish blood supply. 

The third step is the ureter (tube which carries urine from the kidney to bladder) of the donor kidney is connected to the urinary bladder. 

At the end of surgery, the donor is taken off the ventilator and shifted to the ICU for overnight observation; the recipient is generally shifted to the ICU on a ventilator.