Key Points
- It may take several hours after being called up before going to the operating theatre
- Several tubes for monitoring are inserted into the body during surgery
- It is important to get adequate pain relief after a transplant
- Not all transplants work straight away, dialysis may be needed for a while
Tests before the operation
Someone who is called into the hospital for a transplant is not guaranteed to receive it. Before the operation can go ahead, it is necessary to check that you are well enough to have the operation and will not reject the transplant kidney.
1. Physical examination – A thorough physical examination by a doctor is carried out. The purpose of this is to check that it is safe to proceed with the operation. For example, if the patient has a heavy cold, it may considered too much of a risk to have an anaesthetic. If the patient ‹fails’ this assessment they will be sent home and put back on the waiting list.
2. The cross-match – This test is the final hurdle before the operation. The cross-match is a blood test that checks there are no antibodies (substances that normally help the body to fight infection) that would react with the donor kidney. Very high levels of such antibodies in the blood mean that the new kidney could be rejected as soon as it is put in, even if it seems a good match.
A cross-match is done by mixing a sample of the recipient’s blood with cells from the donor’s lymph nodes or spleen or blood. If there is no reaction (i.e., the recipient’s blood does not start attacking the donor’s cells), it is assumed that the new kidney will not be destroyed immediately after it is transplanted. This is called a negative cross-match, and means that the operation can go ahead. There can still be some rejection a few days later which is caused by white blood cells and not the antibodies tested for in the cross-match.
If the cross-match is positive (ie there is a reaction between the recipient’s blood and the donor’s cells), the recipient will usually be sent home and put back on the waiting list. This can be very disappointing, but it is much better to return to dialysis for a while than to be given a kidney that does not work and which may make the recipient extremely ill. If the crossmatch test is only slightly positive, it may be possible to go ahead with a slightly increased risk of rejection.
Virtual cross-match: Most centres offer transplants based on a virtual cross match. This is based on antibodies a cross match could be predicted and if it is negative the surgeon will proceed with the transplant saving critical cold time (kidney in ice).
The transplant operation
An operation to transplant a kidney requires a general anaesthetic and lasts about two to three hours. The surgeon makes a diagonal cut into the abdomen, on the right or the left, below the navel.
The recipient’s own kidneys are usually left in place. The transplant kidney is placed lower down in the abdomen, just above the groin. The transplant kidney has its own artery (to take blood to it), vein (to take blood from it) and ureter (to drain the urine to the bladder).
The artery belonging to the new kidney is attached to the main artery supplying blood to the leg on that side of the body. The vein belonging to the new kidney is attached to the main vein carrying blood from thatleg. These leg blood vessels are big enough to be able to send blood to and from the new kidney without affecting the blood supply to the leg. The transplant kidney’s ureter is attached to the recipient’s own bladder.
A small plastic pipe (called a double J stent) is usually inserted into the ureter to help prevent the ureter from becoming blocked/or urine leak after the operation. At the end of the operation, the abdomen is closed with stitches (usually dissolvable).
Post-operative tubes
When the patient wakes up from the anaesthetic, they will have several tubes coming out of them. These will include:
- a urinary catheter (a tube into the bladder)
- a central venous pressure (CVP) line. (not commonly inserted) This is a tube which goes into a large vein under the collarbone or in the side of the neck, and measures the pressure of blood inside the heart
- an intravenous drip in the arm (to give the patient fluid and drugs if necessary); and, probably
- one or more surgical drains coming out of the abdomen (to drain off any fluid that gathers around the kidney after the operation).
These tubes will be removed one by one over the next few days. The urinary catheter is usually left in place for three to five days.
Pain Relief
Pain relief is very important, and the patient should know how this is being given. Injections or tablets can be given. In many hospitals, the patient can trigger frequent small doses of a strong painkiller after the operation by pressing a button on a wristband. If this is given, make sure you know how to operate the machine.
The first few days after the operation are critical and everyone is monitored very closely. Particular attention is paid to blood pressure, fluid intake and urine output. Most patients are able to drink and eat small amounts on the day after the operation. Petients usually sit out the following day.
The blood creatinine level is measured every day. This shows whether or not the transplant kidney is working. The amount of urine that the new kidney makes is not a reliable indicator, as people who have just had a transplant may produce a large volume of urine that does not contain much waste from the body.
In about one third of kidney transplants, the kidney does not produce any urine in the first few days (and sometimes weeks) after the transplant. This does not mean that the transplant will never work. If the transplant does not work at the start, dialysis will be required and the patient will need to play a waiting game until the kidney starts working. A ‘good transplant’ is one that is working well after one year, not two weeks. CAPD is often not possible immediately after a transplant as the lining of the tummy is close to the site of the transplant and is often cut slightly. Therefore a line may have to be put in a vein in the neck for haemodialysis.
The stay in hospital is usually about two weeks. After leaving hospital, clinic visits are very frequent for months - initially two or three times per week, then once a week, then once every two weeks, etc. When the doctors are satisfied that the kidney is working well, then appointments may be reduced to once every three months or so.
Source Link: https://www.kidney.org.uk/organ-donation/medical-info-transplant-txwhat/medical-info-transplant-txop/
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