Background Information:

What are the other Names for the Procedure?

• Renal Transplant
• Transplantation of Kidney

What is a Kidney Transplantation surgical procedure?

Kidney Transplantation is a procedure to surgically remove a damaged or diseased kidney and replace it with a healthy kidney from a compatible donor.

What part of the Body does the Procedure involve?

A Kidney Transplantation procedure involves the damaged or diseased kidney of the recipient, a (healthy) kidney from a donor, and the blood vessels associated with the kidney and ureters.

Why is the Kidney Transplantation surgical procedure performed?

Kidney Transplantation procedures are required for patients with long-term kidney failure/end-stage kidney disease, when the kidneys are unable to remove waste material from the body.

What are some Alternative Choices for the Procedure?

Long-term dialysis is an alternative to a Kidney Transplantation procedure. However, this is usually not preferred if the individual is a candidate for a kidney transplant.

What are the Recent Advances in the Procedure?

Harvesting the donor kidney using laparoscopic method is a recent advancement.

What is the Cost of performing the Kidney Transplantation surgical procedure?

The cost of Kidney Transplantation surgical procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.
In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Kidney Transplantation surgical procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

United Network for Organ Sharing (UNOS)
P.O. Box 2484 Richmond, VA 23218
Phone: (804) 782–4800
Patient Information: 1 (888) 894–6361
Fax: (804) 782–4817
Email: patientservices@unos.org
Website: http://www.unos.org

http://www.surgery.com/procedure/kidney-transplant (accessed on 08/02/2014)
Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5th Edition, New York, 2006

Prior to Kidney Transplantation surgical procedure:

How is the Kidney Transplantation surgical procedure performed?

A Kidney Transplant procedure involves two major steps:

• Removing a kidney from a live donor or a brain dead donor (termed harvesting)
• And, the actual transplant of the kidney into a recipient

Harvesting the donor kidney:

• The procedure is performed after administering general anesthesia to a live donor and is called nephrectomy
• The skin is incised on the front or on the flank and after dissecting through the layers of the abdomen, the surgeon visualizes the kidney
• The blood vessels supplying the kidney and the ureter are clamped. The kidney along with a portion of the ureter is then surgically removed
• The blood vessels and the ureter stump are sutured. The abdomen is closed in layers and the skin incision is sutured
• Instead of an open nephrectomy procedure with a large incision, a minimally-invasive procedure through the use of laparoscopic techniques may also be performed
• In laparoscopic nephrectomy, small skin incisions are made on the abdominal wall and the abdomen is inflated using carbon dioxide gas. Camera and other medical instruments are introduced through these incisions called “ports” and the kidney removal procedure is followed
• The harvested organ is then preserved in saline preservative solution over ice (for up to 24-48 hours if needed)

Transplantation into recipient:

• This procedure is carried-out under general anesthesia
• The skin is incised over the flank and the harvested kidney is placed by removing the non-functioning, diseased kidney
• The ureter stump is attached to the bladder and the new kidney is connected to the blood vessels to establish circulation

Where is the Procedure Performed?

A Kidney Transplantation procedure is usually performed in a hospital.

Who Performs the Procedure?

The procedure is performed by any of these medical personnel, with assistance from an anesthesiologist:

• A general surgeon
• An urologist with experience in Kidney Transplantation procedures

How long will the Procedure take?

An uncomplicated Kidney Transplantation procedure lasts for 3-4 hours.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Renal Transplant surgical procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• A kidney disease patient first undergoes thorough physical, blood, and radiological examinations, to determine their eligibility for transplantation
• The patient has to then register for an organ transplant and is placed on a waiting list
• A potential donor will also have to undergo a thorough physical exam and blood work-up
• Compatibility between the donor and the recipient must be established and this is of paramount importance
• A psychiatric evaluation may also be necessary
• Normally local anesthesia is not used; however do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
• Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Kidney Transplantation procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Kidney Transplantation surgical procedure?

Before a Kidney Transplantation procedure, the patient has to undergo certain tests such as:

• Routine blood and urine analysis
• X-ray of the kidneys
• Electrocardiography (ECG)
• Computerized tomography (CT) scan
• Ultrasound imaging
• Immunological studies to check for tissue compatibility between a donor and the recipient

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Kidney Transplantation procedure?
• Why is this procedure necessary?  How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed? 
• What are the risks while performing the procedure?
• What are the complications that might take place, during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• What are the costs involved?

During the Kidney Transplantation surgical procedure:

What kind of Anesthesia is given, during the Procedure?

General anesthesia by injection and inhalation is administered for a Kidney Transplantation procedure.

How much Blood will you lose, during the Procedure?

The procedure carries an inherent risk of bleeding and other complications.

What are the possible Risks and Complications during the Kidney Transplantation surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

• Obesity: Generally greater the degree of obesity, greater is the surgical risk
• Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders, chronic infections
• Poor immune system due to a variety of causes

The possible risks or complications that may arise during the surgery are:

• Excessive bleeding
• Infection in the surgical wound
• Anesthetic complications
• The recipient’s immune system rejects the transplanted kidney
• Failure of new donor kidney to function normally during the initial stages, thus necessitating continued dialysis

What Post-Operative Care is needed at the Healthcare Facility after the Kidney Transplantation surgical procedure?

• After the Kidney Transplantation surgical procedure, the patients will be sent to an area of the hospital, called a postoperative recovery area (or PACU)
• The patient’s blood pressure, heart rate, and respiration cycle shall be closely monitored. Any additional pain associated with the procedure will also be treated
• Intravenous (IV) antibiotics may be administered and the patient will be started on drugs, in order to suppress the immune system
• Individuals are usually discharged from the hospital 7-10 days after the surgery is performed 

After the Kidney Transplantation surgical procedure:

What are the possible Risks and Complications after the Kidney Transplantation surgical procedure?

The possible risks and complications that may arise after a Kidney Transplantation surgical procedure include:

• Excessive bleeding
• Infection in the surgical wound
• The recipient’s immune system may reject the transplanted kidney
• Donor kidney rejects its new host
• Leakage and obstruction of the ureter

What is the Prognosis after the Surgery?

• The transplanted kidney may begin functioning immediately or may take several weeks to become functional after the surgery; this depends on many factors
• Once a full recovery occurs, more than 50% of the patients live for 5 years following the Kidney Transplantation procedure, with higher survival rates noted amongst recipients from live donors

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Pain that worsens and swelling around the surgical wound
• Bleeding or fluid drainage from the surgical wound
• The occurrence of any symptom that causes uneasiness, such as nausea and vomiting
• Signs of an infection
• Fever, feeling sick
• Dizziness
• Muscle aches, headaches
• Complications associated with prescription medications used in treatment

What Post-Operative Care is needed at Home after the Kidney Transplantation surgical procedure?

At home, the following post-operative care is recommended after a Kidney Transplantation procedure:

• The transplant recipient should remain on long-term drugs to suppress their immune system. This is to prevent rejection of the transplanted kidney. However, this increases the risk of infection
• Dietary adjustments with modified salt, protein, and fluid intake is necessary
• Slowly resume regular/daily activities as early as possible, which aids in a faster recovery
• Use a heat pad or warm compress to relieve pain due to the incision
• Resume showering and keep the wound clean and dry. Avoid taking baths until the surgical wound is completely healed. Gently wash the surgical wound with an unscented soap (per physician’s advice) and re-bandage the wound again
• Take stool softeners to prevent constipation
• Take antibiotic medication to help combat or prevent infection, as advised by the physician
• Avoid taking nonprescription medications such as aspirin. However, individuals may take acetaminophen to relieve pain, under advise from the physician
• Elevate legs while resting, to prevent the formation of blood clots and reduce the possibility of swelling
• Complete the course of prescribed medication, under advice of the physician
• Avoid all activities that are physically strenuous for about 6 weeks; follow your physician’s advise
• Resume driving only after 2 weeks of being discharged from the hospital, or as advised by your physician
• Avoid sex till complete healing has taken place (under advise by the physician)

How long does it normally take to fully recover, from the Procedure?

The transplanted kidney may begin functioning immediately, or it may take several weeks, depending on various factors.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue is taken for further examination and later disposed as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

• The tissue removed is processed in the laboratory under a pathologist's supervision.
• Slide(s) are prepared once the tissue is processed and is examined by a pathologist and a pathology report issued.
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Kidney Transplantation surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The hospital
• An anesthesiologist (if anesthesia was administered)
• A general surgeon or a urologist with experience in Kidney Transplantation procedures
• A pathologist

The patient is advised to inquire and confirm the type of billing, before the Kidney Transplantation surgical procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA