Surgery

Kidney Transplant Surgery

I. Preparations before surgery (Pre-operative Care)

As soon as a right kidney is available the transplant team will call up the recipient. Once you are called for the transplant operation do not eat or drink anything.

After the patient is admitted in the hospital he will again have thorough examinations. Various procedures like Chest X-ray, ECG, blood and urine analysis will be done to check the status of current health. If any problem (such as infection, abnormally high blood glucose levels etc.) that may interfere with surgery or recovery is detected, the operation may be postponed. However if everything is stable the patient is prepared for the operation:

  • Hair is shaved from the chest and abdomen to prevent infection.
  • Enema or laxatives are given to clean the intestines and prevent constipation after surgery.
  • An IV (intravenous) drip is started to prevent dehydration.
  • Dialysis may be started, if needed.
  • Some immunosuppressant medications (which are required to prevent your body from rejecting the transplanted kidney) and antibiotics are started before the operation.

Kidney transplantation is a major operation and the patient may require blood transfusion, hence necessary preparations should be made before hand.

II. Kidney Transplant Operation

The operation is done under general anesthesia and the procedure usually takes 2-3 hours.

A small incision (8-10 inches long) is made on the right or left side of the lower abdomen just above the groin. The donated kidney is then placed in the lower abdomen through the incision and is attached to the recipient’s blood vessels and bladder. Usually, the nonfunctioning kidneys are left in place. However, if the kidneys are infected or causing uncontrollable high blood pressure they are removed.

III. Management after surgery (Post-operative care)

After the surgery the patient is shifted to the recovery room for observation. The patient is closely monitored for :

  • Maintenance of fluid balance in the body.
  • Cardio-respiratory stability (i.e. the status of heart and lungs).
  • Urine output. In case the urine output is low dopamine infusion and frusemide may be given.
  • Clearance of drugs and their metabolites by the transplanted kidney. Retention of metabolites can lead to certain complications such as respiratory depression.
  • Blood pressure. Low blood pressure can be avoided by appropriate fluid replacement and dopamine infusion, if required. Severe high blood pressure can usually be treated effectively by sublingual nifedipine.
  • Any signs of rejection (i.e. the recipient’s body does not accept the donor kidney).

The length of the stay in the hospital will depend upon the recipient’s condition. Usually one has to remain in the hospital for 1-2 weeks after the transplant operation. If everything is fine the patient is encouraged to move out of the bed on the day following surgery and may resume eating solid food within 2-3 days