Kidney Transplant

Definition:

A kidney transplant is a surgical procedure performed to replace a diseased kidney with a healthy kidney from another person.

A person receiving a transplant usually receives only one kidney, but, in rare situations, he or she may receive two kidneys from a deceased donor.

Types:

The kidney may come from a deceased organ donor or from a living donor.

Family members or individuals who are unrelated but make a good match may be able to donate one of their kidneys. This type of transplant is called a living transplant. Individuals who donate a kidney can live healthy lives with the remaining kidney.

Indication:

• The indication for kidney transplantation is end-stage renal disease (ESRD), regardless of the primary cause.
• Common diseases leading to ESRD include malignant hypertension, infections, diabetes mellitus, and focal segmental Glomerulosclerosis; genetic causes include polycystic kidney disease, a number of inborn errors of metabolism, and autoimmune conditions such as Lupus.
• Diabetes is the most common cause of kidney transplantation.
• The majority of renal transplant recipients are on dialysis ( peritoneal dialysis or hemofiltration ) at the time of transplantation.

Procedure:

Kidney transplantation requires a stay in a hospital. Procedures may vary depending on your condition and your doctor’s practices.

Generally, a kidney transplant follows this process:

You will be asked to remove clothing and given a gown to wear.

An intravenous (IV) line will be started in your arm or hand. Additional catheters may be inserted in your neck and wrist to monitor the status of your heart and blood pressure, as well as for obtaining blood samples. Alternate sites for the additional catheters include the subclavian (under the collarbone) area and the groin.

If there is excessive hair at the surgical site, it may be clipped off.

A catheter will be inserted into your bladder.

You will be positioned on the operating table, lying on your back.

Kidney transplant surgery will be performed while you are asleep under general anesthesia. A tube will be inserted through your mouth into your lungs. The tube will be attached to a ventilator that will breathe for you during the procedure.

The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.

The skin over the surgical site will be cleansed with an antiseptic solution.

The doctor will make a long incision into the lower abdomen on one side.

The doctor will visually inspect the donor kidney prior to implanting it.

The donor kidney will be placed into the abdomen. A left donor kidney will be implanted on your right side; a right donor kidney will be implanted on your left side. This allows the ureter to be accessed easily for connection to your bladder.

The renal artery and vein of the donor kidney will be sutured (sewn) to the external iliac artery and vein.

After the artery and vein are attached, the blood flow through these vessels will be checked for bleeding at the suture lines.

The donor ureter (the tube that drains urine from the kidney) will be connected to your bladder.

The incision will be closed with stitches or surgical staples.

A drain may be placed in the incision site to reduce swelling.

A sterile bandage or dressing will be applied.

Contraindication:

• Contraindications include both cardiac and pulmonary insufficiency, as well as hepatic disease.
• Concurrent tobacco use and morbid obesity are also among the indicators putting a patient at a higher risk for surgical complications.
• Many Kidney Transplant programs place limits on age (e.g. the person must be under a certain age to enter the waiting list) and require that one must be in good health (aside from the kidney disease).
• Significant cardiovascular disease, incurable terminal infectious diseases and cancer often are transplant exclusion criteria.
• In addition, candidates are typically screened to determine if they will be compliant with their medications, which is essential for survival of the transplant.
• People with mental illness and/or significant on-going substance abuse issues may be excluded.
• HIV was at one point considered to be a complete contraindication to transplantation. However, some research seems to suggest that immunosuppressive drugs and antiretroviral may work synergistically to help both HIV viral loads/CD4 cell counts and prevent active rejection.