Thursday, 12 September 2019

Kidney Transplantation

Kidney Transplantation

Kidney Transplantation

Kidney Transplantation is a surgery done to replace a diseased kidney with a healthy one from a donor. The healthy kidney or ‘graft’ takes over the functions of non-working kidneys. Before receiving a kidney transplant, the patient must undergo a detailed medical evaluation. This evaluation is done with the objective to determine whether the patient would benefit from a transplant and can withstand the surgery, graft rejection, medications, etc.
The transplantation 'Kidney Transplantation' is carried out under the supervision of a transplant team. It includes a transplant surgeon, a transplant nephrologist, nurses, an anesthesiologist, dietician, and a psychiatrist.

Matching Donor and Recipients

The kidney to be replaced may either come from a deceased organ donor or a living donor. The potential recipient for the donor's kidney is screened for compatibility of both of them. It includes the blood type, body sizes of the donor, a negative lymphocytotoxic cross match and the number of HLA antigens common between the donor and recipient based on tissue typing.

Kidney Transplantation

  1. The surgeon makes about 1½ inch incision below the ribcage.
  2. Two fingers are then inserted into the incision, to maneuver the kidney.
  3. The kidney is separated from connective tissue that holds it in place.
  4. The blood vessels and the ureter are dissected.
  5. The surgeon is then able to lift the kidney out of the patient and ready to be implanted into the recipient.

Kidney Transplantation

Living Donor Nephrectomy

The medically fit prospective donor is evaluated and assessed for the anatomical features of the kidney. Once this is done, nephrectomy (i.e., surgical removal of kidney) is safely performed. It is done either by open surgery or by laparoscopic approach.

The right lateral position of the donor for left nephrectomy. Lateral decubitus position Modified with hips rotated back and arm extended above the head. The table is flexed to expand the area between the costal margin and pelvic brim.

Preparation for Surgery of Recipient

An intravenous line is inserted in the patient’s arm or hand to supply medicines and catheters are put in neck and wrist to monitor the status of heart and blood pressure. Another urinary catheter is inserted into the bladder. After the placement of central and arterial lines and induction of anesthesia, the recipient is prepared for surgery (draped and positioned on the operating table, lying on back). A tube has inserted by the mouth into the lungs. This tube is attached to a ventilator that allows the patient to breathe during the procedure.


Kidney Transplantation

The surgeon inspects the donor's kidney and implants it into the recipient’s abdomen. A right donor kidney will be implanted on the left side and vice versa. This allows the easy access to ureter for connection to bladder. The renal artery and vein of the donor's kidney are joined to the external iliac artery and vein and flow of blood through them is checked for bleeding at suture lines. The incision is closed with stitches and a sterile bandage is applied.

Post-Kidney Transplantation

After surgery, complications such as infection, blockage of blood vessels, bleeding, leakage or blockage of urine in the ureter, etc., may occur. There is also a probability of kidney being rejected by the recipient as the patient’s immune system reacts to the new foreign organ. For the survival of the transplanted organ, immunosuppressants are given to trick the immune system. These medications do have serious side effects, therefore, everyone is not suitable for kidney transplantation.

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