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Definition
A surgical procedure to place a healthy kidney, from a donor, in a patient with severely diseased and damaged kidneys. The donor may be a living relative, a close friend whose tissue closely matches yours, or someone who has died and donated his or her organs.
Anatomy of the Kidney
2008 Nucleus Medical Art, Inc.
Parts of the Body Involved
The transplant involves the kidney, ureter, and the involved blood vessels.
Reasons for Procedure
A kidney transplant is done to treat irreversible, end-stage kidney diseases. The procedure is most often performed when the kidneys fail for the following reasons:
- Diabetes
- Systemic lupus erythematosus
- Interstitial nephritis
- High blood pressure
- Glomerulonephritis a kidney disorder
- Polycystic kidney disease
- Damage from severe pyelonephritis inflammation in the kidney, often due to bacterial infection
Risk Factors for Complications During the Procedure
- Pre-existing medical conditions, especially certain heart, lung, and/or liver diseases
- Autoimmune disease
- Age extreme (young or old), of either the recipient or the donor
- Difference in race between the recipient and donor
- Prior blood transfusion
- Prior failed transplant
- Pregnancy
- Conditions that will likely result in a recurrence of kidney failure in the new kidney
- Cancer
- Certain infections, such as osteomyelitis , tuberculosis , hepatitis
What to Expect
Prior to Procedure
Because of a shortage of donors, you may be on a transplant list for some time. You may need to carry a pager or cellular phone at all times so that the transplant team can reach you if a donor kidney becomes available.
Your doctor will likely do the following: Physical examReview of medicationsBlood tests to include blood chemistries, liver function, coagulation, and to assess infectious profileElectrocardiogram (ECG, EKG) a test that records the heart's activity by measuring electrical currents through the heart muscle Chest x-rayExtensive tissue typingYou may be asked to undergo psychological testing and counseling to ensure that you are well-prepared for the stress of this procedure. The days leading up to your procedure: Continue renal dialysis as directed by your doctor.Take medications as directed; do not take over-the-counter medications without checking with your doctor.The night before, eat a light meal and do not eat or drink anything after midnight unless told otherwise by your doctor.Arrange for help at home after returning from the hospital. During ProcedureYou will receive IV fluids, antibiotics, and anesthesia. AnesthesiaGeneral anesthesia will be used for the transplant surgery. Description of the ProcedureThe surgeon cuts into the lower abdomen and connects the donated kidney to your arteries, veins, and ureter, which carries urine to the bladder. The diseased kidneys are usually left in place. The incision is closed. Your new kidney may start producing urine immediately or within a short time.
After ProcedureA catheter that is connected to a bag collecting urine will be left in your bladder. How Long Will It Take?The surgery typically takes about 3-6 hours. Will It Hurt?Anesthesia prevents pain during surgery. You may experience pain while recovering, but you will receive pain medication to relieve this discomfort. Possible ComplicationsInfectionRejection of the new kidneyLeakage from ureter Heart problems from prior heart disease (such as heart attacks , heart failure , or heart rhythm problems) Blood clot in the bladder or vein connected to the kidney Postoperative diabetes Gastrointestinal ulcers sores in the lining of the stomach or intestines Phlebitis blood clots of a vein Excessive swelling of your wound or legsDamage to blood vessels or nervesCancer risk due to prolonged use of immunosuppression drugsUrinary obstructionKidney stones You are also specifically at higher risk for activation or progression of a number of diseases due to the use of immunosuppressive drugs, including: Recurrence of cancer Liver disease if you have hepatitis C or B Infections like tuberculosis or AIDS if you are infected before surgery Average Hospital StayThe typical recovery time in the hospital is 1-2 weeks.
Postoperative CareTake deep breaths and cough 10-20 times every hour to decrease the risk of fluid building up in your lungs and pneumonia.Expect to get out of bed the day after surgery.You will be started on drugs to suppress your immune function and therefore decrease the risk that your body will reject your new kidney.You may be given steroid medications to decrease inflammation in your new kidney.You may be given diuretic medications to help rid your body of accumulated fluid.Only take medications approved by your doctor.Your new kidney may be monitored via ultrasound examinations and nuclear medicine scans.You may be asked to weigh yourself, take your blood pressure daily, and to measure the amount of fluids you take in as well as the amount of urine you pass.The amount of salt and protein you eat may be restricted.You may be asked to avoid alcohol for at least a year. OutcomeAfter a period of recuperation, you will most likely be able to return to work and normal activities.To reduce the chance that your body will reject the donor kidney, you will need to take immunosuppressive drugs for the rest of your life. Additional drugs may be ordered to manage side effects. These drugs may increase your risk of developing cancer, kidney disease (in the new kidney), and weak bones.
More than 80% of transplanted kidneys from cadaver donors remain working after one year. The success rate often improves with a kidney from a living donor, because the donated tissue more closely matches your tissue. Call Your Doctor If Any of the Following OccursSigns of infection, including fever and chillsRedness, swelling, increasing pain, excessive bleeding, or discharge from the incision siteCough, shortness of breath, chest pain, or severe nausea or vomitingPain, burning, urgency, frequency of urination, or persistent bleeding in the urinePassing no or only small amounts of urinePain and/or swelling in your feet, calves, or legs, or sudden shortness of breath or chest painCoughing up bloodSudden headache or feeling faintMalaiseHigh blood pressureWeight gain greater than three pounds in one day RESOURCES: National Kidney and Urologic Diseases Information Clearinghousehttp://kidney.niddk.nih.gov/index.htm National Kidney Foundationhttp://www.kidney.org CANADIAN RESOURCES: The Kidney Foundation of CanadaNorthern Alberta and the Territories Branchhttp://www.kidney.ab.ca The Kidney Foundation of CanadaBritish Columbia Branchhttp://www.kidney.bc.ca References: Akbar SA, Jafri ZH, Amendola MA, et al. Complications of renal transplantation. RadioGraphics . 2005; 25: 1335-1356.
Cecil Textbook of Medicine . 21st ed. WB Saunders Co; 2000. Halloran PF. Immunosuppressive drugs for kidney transplantation. NEJM . 2004; 351: 2715-2729. Kaufman DB. Renal transplantation. eMedicine website. Available at: http://www.emedicine.com. National Kidney and Urologic Diseases Information Clearinghouse website. Available at: http://kidney.niddk.nih.gov/index.htm. Textbook of Surgery . 16th ed. WB Saunders Co; 2001. Last reviewed November 2007 by A. Carmack, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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