Kidney Transplant Surgery

The kidneys are two bean-shaped organs located just below the rib cage on either side of the spine. Each one is the size of a fist. The main function of the kidneys is to filter wastes, minerals and fluid from the blood by producing urine, and to filter out some harmful and waste materials through urine. When your kidneys lose this filtering ability, harmful fluid and waste materials build up in your body. This can lead to high blood pressure and end-stage renal disease. End-stage renal disease occurs when the kidneys lose about 90 percent of their normal function. Treatment options for end-stage renal disease include dialysis and kidney transplantation.

Common causes of kidney failure include:

· Diabetes

· Chronic, uncontrolled high blood pressure

· Chronic glomerulonephritis – inflammation of the small filters (glomeruli) in your kidneys and eventually permanent loss of function

· polycystic kidney disease

· Living donor kidney transplantation is an extremely comfortable method for both the recipient and the donor. However, very successful results are obtained in kidney transplantation from a person who has brain death.

What is Kidney Transplantation?

Kidney transplantation is the process of replacing the failing kidney with a kidney taken from a living or cadaver, and ensuring that the kidney functions of the person continue.

Our kidneys are vital organs. Chronic kidney failure means permanent deterioration of kidney function. Currently, the only known treatment of chronic kidney failure is kidney transplantation, which is the most common organ transplantation. Kidney transplantation can also be performed in emergencies, called acute kidney failure. Kidney transplantation allows the patient to regain his health with a surgery. Dialysis should not be considered as an alternative to kidney transplantation as it can only (partially) restore some kidney functions. Moreover, for patients on dialysis, various adverse events such as strict diets, water restriction, travel barriers, isolation from social life, being left behind from work or education, and developmental delay in pediatric patients may occur. Patients on dialysis have to use drugs intensively because they are deprived of most of the functions performed by the kidneys. For these reasons, it is known that kidney transplant patients have better quality of life and duration of life than patients on dialysis. Patients can continue their lives as healthy individuals with a successful kidney transplant and postoperative follow-up.

How is Kidney Transplantation performed?

Despite all the efforts made all over the world, cadaveric transplants from people with brain death have not reached a sufficient level and these numbers have been increasing very slowly over the years. As a solution to organ failure, kidney transplants from living donors have come to the fore.

Donor Surgery

Considering the health and postoperative comfort of living kidney donors, it is quite common to remove the kidney with the closed method (laparoscopic method). With the closed method, the surgery is performed through small holes in the patient's abdomen instead of making a large surgical incision in the patient's body. Kidney surgery with the closed method is performed through 3 holes of 0.5-1 cm in the abdomen of the patient, and at the end of the operation, the kidney is removed through a 5-6 cm incision made in the inguinal region of the patient. Compared to open surgery, patients experience less pain after the operation, stay in the hospital for a shorter time, and return to their normal lives and work faster. In the open method used in the past, undesirable side effects such as hernia, numbness, wound infection, which are seen after the surgery in patients, are almost never seen in this technique. This operation, which is performed only through 3 holes opened to the body and a small incision to remove the kidney, provides successful results in cosmetic terms compared to open surgery. Donors who start walking, drinking water and eating food on the evening of the operation can be discharged 2 days after the operation. The sutures are hidden and aesthetic sutures and these sutures do not need to be removed after the surgery.

Recipient Surgery

Kidney transplantation is a surgery performed by reaching the inguinal veins from outside the peritoneum. In kidney transplant surgery, the kidney is placed in the right or left inguinal region, not in its original place. The vessels of the donor kidney are joined with the inguinal veins of the recipient, and the urinary tract of the donor kidney with the recipient's bladder with the help of sutures. The patient's non-functioning kidneys are usually not removed, except in rare cases.

Recovery process after kidney transplant is very fast. Since there is no contact with the intestines during the operation, the patient begins to eat very quickly after the operation. In the first 4 days, the urine output of the patients who are followed up with a urinary catheter, are removed on the 4th postoperative day.

If a kidney transplant was performed from a living donor, the patient is usually discharged on the 5th day, as kidney function begins immediately. However, if a cadaveric kidney transplant was performed, a longer hospital stay may be required, as the kidney will begin to do its job in a few days or weeks.

FAQ

How does the Kidney Transplant evaluation process work?

The kidney transplant evaluation process begins with the determination of donor and recipient blood groups and tissue types.

Blood Group Test

There are four blood types: A, B, AB, and O. Everyone fits into one of these hereditary groups. There must be blood group compatibility between the recipient and the donor. The following list shows the compatible blood groups:

If the recipient's blood type is A, the donor should be either A or O.

If the recipient's blood type is B, the donor should be blood group B or O.

If the recipient's blood type is O, the donor blood type should be O.

If the recipient's blood type is AB, the donor blood group can be A, B, AB or O.

AB blood group is the easiest to match. Because a person with AB blood type accepts all other blood types.

Tissue Typing

The second test, which is a blood test for the determination of human leukocyte antigens, is called tissue typing. Antigens are markers found on many cells of the body that uniquely distinguish each individual. These tokens are inherited from parents. Tissue typing test is a blood test that shows a person's genetic makeup (genetic fingerprint). As with blood group compatibility, it is investigated whether the tissue types of the donor and recipient match.

Cross Match

Throughout life, the body produces substances called antibodies that help destroy foreign substances. When a donor kidney is available, a test called crossmatch is done to make sure the recipient does not have preformed antibodies against the donor.

Cross-matching is done by mixing the recipient's blood with cells from the donor. If the crossmatch is positive, it means there are antibodies against the donor. The recipient should not receive this kidney unless specific treatment is given prior to transplant to lower antibody levels. If the crossmatch is negative, it means that the recipient has no antibodies against the donor and is eligible to receive this kidney. Several cross-matches are performed in preparation for a living donor transplant, and a final cross-match is performed 48 hours before such transplant.

Serological Tests

Testing is also done for viruses such as HIV (human immunodeficiency virus), hepatitis and CMV (cytomegalovirus) to select appropriate preventive drugs after transplantation. These viruses are controlled in any potential donor to help prevent the spread of disease to the recipient.

Who cannot be a living donor for a Kidney Transplant?

· Persons under the age of 18

· Those with hypertension (>140/90 mmHg) or using hypertension medication

· Diabetes

· People with morbid obesity

· Bilateral or recurrent nephrolithiasis (kidney stones)

· Those with a history of thrombosis or thromboembolism

· Those with chronic kidney disease (CKD)

· Those with history of pulmonary embolism or recurrent thrombosis

· Those with psychiatric illnesses

· Those with serious medical illness (chronic lung disease, recently diagnosed cancer)

· Low GFR (< 80 ml/min)

· Proteinuria (>300 mg/24 hours)

· Those with history of pulmonary embolism or recurrent thrombosis

· Those with HIV infection

What are the possible risks and side effects of Kidney Transplant surgery?

Possible risks after kidney transplant surgery include:

· Temporary kidney function deficiency: Your new kidney may not start working right away. You may need dialysis until kidney function returns.

· Organ rejection: Your body may reject the donor organ and you may need certain medications to help your body accept the new kidney.

· Kidney failure: Chronic rejection may begin years later. The kidney may lose its functions after a while, similar to the first kidney disease. As a result of this situation, you may need to have a second transplant or go on dialysis again.

· Vulnerability to cancer: The immunosuppressant drugs used after the transplant can make you more vulnerable to cancer.

· Diabetes: Drugs taken after kidney transplant can cause diabetes.

· Narrowing of the artery that carries blood to the kidney

· coagulation in veins

· Infection

· Bleeding

· Gaining weight

· Hypertension

What is the recovery time after Kidney Transplant?

Two weeks after the kidney transplant, you start to feel much better; however, you must use anti-rejection medication regularly after the transplant.

What lifestyle changes does a patient need to make?

It is recommended that transplant patients do not participate in contact sports. (Boxing, wrestling, football, basketball, etc.) After the transplant, one should stay active, avoid smoking and alcohol, and follow a healthy diet program.

Can anyone be a live donor?

Anyone can be a living donor under medical and legal conditions.