Renal (Kidney) Transplantation

 Renal (Kidney) Transplantation

The goal of surgery:

The goal of kidney transplantation is to provide a kidney that can perform its functions, for a person who has lost the kidney and has the ability to perform its functions, due to many factors that cause end-stage renal disease to reach: such as chronic renal failure (Chronic renal failure), Kidney damage due to diabetes, renal hypertension, chronic kidney infection, damage to the kidneys due to drugs, exposure of the kidney arteries to damage, hereditary kidney diseases, damage to the kidneys after autoimmune disease (Autoimmune) and others.

End-stage renal disease is characterized by a decrease in the renal clearance rate to 20-25% of normal (glomerular filtration rate (GFR))

A kidney can be obtained for the purpose of transplantation either by a living or dead donor, but certainly the living donor is preferred, so that comprehensive checks can be performed for this donor before the transplantation process, and thus the chances of the body rejecting the transplant are reduced, and in order to increase the chances of success of the transplant in Patient. Moreover, the average life of a kidney taken from a living donor is twice as long as a kidney taken from a dead body.

The course of kidney transplantation includes the first surgery for the donor in order to remove the healthy kidney (in most cases this is done by making a small incision and removing the kidney through laparoscopic surgery), and the second surgery is for the recipient of the kidney in order to transplant the kidney into his body.

Preparing for surgery:

There is no need in the present day to match the kidney tissues or blood type in order to perform a kidney transplant, because there are good treatments that are used after transplantation and that contribute to the body's reception of the transplant with a high success rate of 85%.

In cases where these treatments cannot be used, a donor with HLA kidney tissue must be found suitable for the patient’s kidney and the blood type must be appropriate.

After finding this donor who can survive after surgery, he must declare that he is a donation from humanitarian and not financial motives.

The tests required to perform the transplant in the patient who will receive the transplant sometimes include an ultrasound of the kidneys, a comprehensive blood count (CBC), blood chemistry, examination of kidney function and blood type, as well as a urine test.

Also, the donor must do most of these checks, which were mentioned above. The patient should consult the doctor about the medications that he should stop taking before surgery. He must also fast for a full 8 hours before the surgery, which is performed under general anesthesia.

Course of surgery:

At the same time that the kidney is removed from the donor, the surgery for transplantation of the kidney into the body of the receiving patient is also prepared.

First, the abdominal area is thoroughly sterilized. Then, an abdominal incision is performed, so that the incision penetrates all layers of the skin, subcutaneous tissues, muscles and abdominal membranes until the kidney located in the posterior-lateral section of the abdomen (retroperitoneum) is reached. After the renal blood vessels are stripped, the ineffective kidney is removed from its place, and placed in a new form in the pelvic cavity (the kidney is not completely removed in most cases, as research has shown that removing the kidney and removing it from the body is associated with a greater death rate after surgery. Today these kidneys are kept in the body, but elsewhere.)

After that, the integrity of the abdominal cavity is checked and prepared for implantation. The donor kidney is attached to the renal blood vessels, and it must be ensured that the blood reaches them well. At the end of the transplant phase, the ureter (Ureter) is connected from the new kidney to the patient's bladder.

After that, the abdominal membranes, the muscles of the abdominal wall and the skin layers are sutured. The incision is bandaged. In most cases, a drained tube is kept inside the abdomen (tube connected to a plastic balloon), in order to absorb fluid residues and bleeding that have accumulated inside the abdominal cavity. This surgery takes 5 hours and even more.

Risks of surgery:

General risks for all surgeries:

Infection in the incision - in most cases the infection is superficial and is treated topically, but in some rare cases serious infection may occur in the layers of the skin, subcutaneous tissues or in the abdominal cavity. In some rare cases, there is a need to open the incision again to remove the germ residue.

Bleeding - occurs mainly in the area of ​​the operation due to the exposure of the tissues in this area to local trauma. Bleeding may occur immediately after surgery and may appear 24 hours after the end of the operation. In some rare cases, it may appear after several weeks or even months. This bleeding occurs as a result of rupture and bleeding of small or large blood vessels. In cases where the bleeding is severe, additional drainage is needed. Heavy bleeding that may cause significant blood loss. Surgery may be required to close these bleeding vessels.

Scar - How a scar heals is dependent on the quality of the stitches and genetic factors. There is no way for us to predict how the scar will recover after surgery.

Risks of anesthesia - most of the symptoms are related to hypersensitivity to narcotic substances (allergic response). In rare cases, a dangerous drop in blood pressure (anaphylactic shock) may occur.

Risks of this surgery:

Renal blood vessel damage - after ligation or due to the use of acute surgical tools - is rare.

The ureter is damaged.

Acute transplant rejection - which appears as a severe immune reaction by the body against the transplanted kidney, if this occurs up to 60 days after the transplant. Today, many medications are taken to prevent this.

Treatment after surgery:

After a kidney transplant, the patient must lie in the hospital for recovery and remain under observation for 4-7 days. In most cases, this transplanted kidney supplies urine immediately, and it reaches a normal performance rate within a week or two (the kidney taken from a dead body needs more time to reach the normal performance rate). If problems with urination are proven, diuretic medications are added to help the new kidney function.

As mentioned, medications are taken in order to suppress the patient's immune system, with the aim of preventing transplant rejection as much as possible. These drugs are used for long periods and in some cases they are taken for life. However, they require extensive follow-up of blood tests and kidney function due to their various side effects.

If the patient feels pain after a kidney transplant, he can take pain relievers as needed.

Compresses and stitches are often removed from the incision a week after surgery.

In every case where a sudden rise in temperature, hypotension, or urine retention occurs, the attending physician should be informed.