Transplant Center

The Operation

A kidney transplant is performed by placing the kidney on the right or left side of the lower abdomen. An incision is made to implant the new kidney, attach it to the necessary blood supply and to the bladder for urine drainage. Generally, the native kidneys are left in place; however, exceptions to this may be made in the event of infection, the potential for infection, the presence of cancer, and in some cases, if a patient has very large kidneys as seen with patients who have polycystic kidney disease.

Other surgical options include:

• Open Donor Nephrectomy
  An "open" donor nephrectomy is done through a flank incision either on the left or the right side of the abdomen, just above or just below the twelfth rib. This type of donor nephrectomy is considered the standard or traditional method of removing a kidney and can be fairly painful. Average length of stay in the hospital is four to five days and return to work after discharge can be four to six weeks, especially if the job involves heavy lifting.
• Laparoscopic Donor Nephrectomy
  Laparoscopic donor nephrectomy is a procedure in which the kidney is removed from the donor through several small (approximately one-inch) incisions. The operation is performed with the aid of a camera, which is inserted through one of the small incisions. Pencil-thin instruments are inserted through the other incisions. At the end of the procedure, the kidney is removed through a five- to seven-inch incision that extends slightly above and slightly below the belly button.

The potential benefits of removing the kidney laparoscopically (instead of the traditional "open" procedure) include less post-operative pain, a shorter hospital stay and overall quicker recovery time. The average length of stay after laparoscopic donor nephrectomy is about three days and most donors are ready to return to work in three to four weeks. A donor whose work involves heavy lifting is still required to recover for six weeks before returning to full duty. However, many times employers will allow the donors to return to "light duty" until their six-week recovery is completed.

After the Operation

After the operation, you will be in either a private room on the Solid Organ Transplant Unit or in the Intensive Care Unit for recovery. The new kidney should start to work soon after the surgery, but it may be necessary to have dialysis in our inpatient dialysis facility until it does begin to work.

You should able to walk around and start eating a normal diet within a few days after the surgery. During this time, the staff closely monitors your progress with the appropriate tests to see how the new kidney is working.

The transplant coordinator and doctors will instruct you on the following:

• How to take your medications
• Warning signs to look for
• How to read blood tests to watch for early signs of any problems
• When to call the Transplant Office

Immunosuppressive (Anti-rejection) Medications

Both before and after the transplant surgery, you are given immunosuppressive (anti-rejection) medications. These are strong medications to help prevent rejection. These medications must be taken as long as you have the transplanted kidney. To determine a safe level of these drugs, your blood will be tested and the medication levels will be watched very closely by the transplant team.  It is very common for the transplant team to make frequent changes in medication doses after transplant to keep the anti-rejection medications in a safe range and yet prevent rejection.

Some problems occur as a result of the side effects of the needed medications. The most common side effect is the lowering of the ability to fight infection. The transplant surgeon and coordinator will discuss other potential problems that include signs and symptoms of rejection and infection.

Potential Complications

All treatments for kidney disease have special problems. Transplantation is no different. As a transplant patient you need to be aware of the possibility of rejection and infection.

Rejection occurs when the body fights the donor's kidney. This happens because the new kidney is a foreign tissue. Rejection is the most common reason for transplant failure. There are three types of rejection:

• Hyper-Acute Rejection- this type is very rare, but can occur minutes or hours after surgery. This isn't treatable. If it happens, the kidney must be removed and dialysis must be resumed until another kidney is available.

• Acute Rejection- this can occur anytime but is most common in the first year after transplant. This type of rejection is usually reversible with anti-rejection medications.

• Chronic Rejection- this occurs slowly and over a long period of time. There is usually no treatment. The kidney's function may decrease to the point that dialysis is required. If this occurs, the patient may decide to try another transplant. Some patients have had two or more transplants.

The Cost

Medicare and/or private insurance companies usually cover the cost of a kidney transplant. Some insurance companies may not cover the cost of medications needed after the transplant. A transplant financial counselor, transplant pharmacy counselor and a social worker will answer questions regarding insurance coverage, Medicare A, B and D, coordination of benefits, prescription coverage and other financial concerns.

Making the Choice

In most cases, a kidney transplant offers you the best chance of returning to the highest quality of life possible. If you have questions, contact the kidney transplant office at (402) 559-5000.