Kidney transplant surgery – Everything you need to know

Overview:

When we are looking at a surgery like this, what is the kidney transplant definition? We are born with a pair of bean-shaped organs called kidneys which are placed on each side of the spine. They reside against the back muscles in the abdominal cavity, opposite each other. A kidney transplant surgery is performed when one or both kidneys fail to perform normal functions and even dialysis isn’t helping much. This stage is called End-Stage Renal Disease (ESRD) or kidney failure. The donor for a kidney could be living or dead.  These surgeries are very successful and the patient can lead a normal healthy and long life post a kidney transplant. Transplant relieves the patient from daily dialysis.  C:\Users\HP\AppData\Local\Microsoft\Windows\INetCache\Content.Word\retro-cartoon-of-2-kidneys.-concept-of-losing-one-kidney-622898254_4122x4120.jpeg

Indications:

Since the body requires fresh and clean blood to be healthy, failure of kidney function builds up toxins and excess fluid in the body which can lead to multiple organ failures, seizures or even coma. Some of the symptoms demanding a kidney transplant are:

  • Excessive and constant tiredness due to fewer red blood cells produced when kidneys fail

  • Shortness of breath because of fluid retention

  • Faintness, dizziness due to lack of oxygen

  • Swelling in ankles, face, under eyes, over the abdomen

  • Bad breath, lack of appetite, and tastelessness

  • Excessive itching all over

  • Uncontrollable passing of urine or minimal to no urine: As the kidney, which makes urine stops functioning, the complete system of passing urine changes and sometimes excessive and uncontrollable and frequent urine takes place.

Medical conditions that can lead to kidney transplant eventually-

  • High blood pressure

  • Diabetes

  • Glomerular nephritis

  • Lupus

  • Polycystic kidney

  • Renal tumour

  • Any other cause leading to kidney failure

Pre-procedure

Once the doctor and patient decide that a kidney transplant is needed, a certain amount of preparation is needed prior to undergoing a major surgery like this. This is the period when a patient is on the waiting list to receive a donor kidney from a dead donor or before the completion of the evaluation done for a potential living donor like a friend or family member.

The patient goes through a series of tests to make sure that the patient is fit and will be able to tolerate the medications post-surgery:

Mental health evaluation:

In this, the doctors check your psychological stability as psychological and social issues can affect the transplant process in the bigger picture. This evaluation is also done for the living donor. Any myths regarding the transplant are also cleared.

Blood tests:

These tests are done to find the best donor match, to check where you stand on the donor list and to see if the donor organ will not be rejected.  Also, complete blood count, a renal profile that includes BUN, creatinine, and glomerular filtration rate (GFR) and urine tests will be conducted.

Diagnostic tests

These tests are done to assess overall health. These tests may include x-rays, ultrasound, kidney biopsy etc. Women may also have to get a mammogram, pap test, and a gynaecology evaluation.

Before the surgery, you may be given dialysis if you have been taking dialysis in the past. You will be given a consent form to sign by the hospital. Read through it and ask questions if you don’t understand anything. If you have a living donor then you may have to be empty stomach 8 hours before the surgery.

Procedure

So this is what the kidney transplant procedure entails.

  • The skin which over the surgical site is cleansed with an antiseptic solution. Hair in the area is shaved before this.

  • A long cut will be made into the lower abdomen on the side the transplant is needed. The donor kidney will be visually inspected before placing it.

  • In a transplant, general anaesthesia is given so that the patient feels no pain and is sedated through the entire procedure. The procedural is usually 2-4 hours long. In this, the new kidney isn’t placed in the same location as the original kidneys. It will be placed in the front part of the lower abdomen, in the pelvis.

  • A left donor kidney will be placed on the right side and a right donor kidney on the left side. This will allow for the easy connection of the ureter to the bladder. C:\Users\HP\AppData\Local\Microsoft\Windows\INetCache\Content.Word\Kidney-Transplant-177347568_4000x5000.jpeg

  • The external iliac artery and vein will be attached to the renal artery and vein of the donor’s kidney.

  • After this, the blood flow will be checked to see if there is any bleeding at the suture lines.

  • The ureter from the donor’s kidney will be connected to the patient’s own urinary bladder.

  • The incision will be shut using stitches or surgical staples.

  • A drain may be placed where the incision is made to drain away blood and reduce swellings.

  • In the end, a sterile bandage or a dressing will be placed to protect the wound.

Recovery

A very commonly inquired question is what is the kidney transplant recovery time?

  • Usually, the hospital recovery for a kidney transplant is 7-10 days if there are no complications. The duration of the stay is completely dependent on how fast you recover.

  • After the surgery, you will be taken to the intensive care unit, where you will be kept under observation for at least 24-48 hours. Then you will be taken to the transplant care for the remainder of the period of your hospital stay. If there is progress in your recovery, you may even be able to get up from the bed the day after surgery.

  • Before you leave for home, check up on your follow up care which includes medications and lab tests.

Complications

Potential complications include-

  • Bleeding

  • Blood Clots

  • Infections

  • The failure of the donated kidney

  • Rejection of the donated kidney.

  • Leakage from or blockage of the ureter which connects the kidney to the bladder

  • Infection or cancer that can come along with the donated kidney

  • It can also result in the heart attack or death of the patient

  • If you see any symptoms of fever, pain, rash, nausea, vomiting and a sudden drop in the urine output, contact your doctor immediately.

Care at home

Your role is pivotal in your process of recovery so you need to be regular for your follow up care and listen to the instructions that your doctors give. The first clinic appointment after your surgery is of utmost importance.

  • You will be taking immunosuppressant medications for a few weeks to prevent any complication like transplant rejection. You need to keep yourself healthy and not get infected. If the medication isn’t followed it may lead to the failure of the kidneys functioning. Report any kind of side effects that you sense to your doctor.

  • Walking is essential after your transplant as it helps reduce the swelling and hastens the healing process. Around four to six weeks after surgery other light forms of exercises can be added. No strenuous workouts are permitted for at least 3 months’ post-surgery.

  • Start your daily routine processes slowly and gradually.

  • Clean hands are key to fast recovery. Wash them before and after every meal, touching soiled items or surfaces, after using the washroom. Ask others who are around you to wash their hands too.

  • Avoid sun exposure for longer periods of time. The medications that you are taking in may involve a risk of skin cancer. Thus, always use a sunscreen that is SPF20 or higher.

  • Wash your hands thoroughly after petting an animal. Do not pick up your pet waste with naked hands and always wash your hands after picking it with the use of gloves.

  • Keep your house extremely clean and have a minimum number of houseguests around you around the first six to eight weeks’ post-surgery. Tell your family members and friends to avoid meeting you if they aren’t keeping well. Keep younger children at a distance too. Avoid eating from buffets as they harbour a lot of bacteria.

  • Keep your activities at a bare minimum level as your immune system will need time to settle with your medications.

  • Avoid places that are crowded as it increases the risk of getting infected.

  • Take meticulous wound care as instructed.

  • Keep up with your doctor’s appointments.

  • Maintain a healthy and nutritious diet.

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