In The Operating Room
Before you go into the operating room, you will be asked to remove your clothes and put on a hospital gown. The transplant team will start an intravenous line in your arm or hand. The IV will deliver fluids and medications during your surgery.
The team will insert a catheter into your bladder to collect urine as your new kidney starts working.
The team will insert a tube into your mouth that allows us to connect you to a machine that will help you breathe while under anesthesia.
We may need to shave hair off of your abdomen to prevent infections. We will clean your abdomen with a special solution before the surgeon makes the incision.
Your surgeon will make the incision to implant the new kidney. Once your surgeon connects the kidney to your veins, arteries and bladder, the surgeon will close the incision with staples or stitches. We may use a dressing bandage to protect the surgical site.
Unless your native kidneys are causing a problem, they will remain in your body. This is because the surgery to remove your own kidneys would be greater than the surgery to implant a new kidney.
What Is A Kidney Transplant
A kidney transplant is a surgical procedure in which a new kidney from a donor is transplanted into a recipients body. Kidneys play many important roles, but their main function is to filter waste products from the blood and removing them by producing urine which will be passed out of the body.
Medical condition such as kidney failure or end-stage renal disease is a condition in which the kidneys lose their ability to filter out the waste products. The build-up of the waste or toxic substances in the body can be potentially life-threatening. This is the most common reason for needing a kidney transplant.
Kidney failure patients are first recommended dialysis, a blood-filtering procedure that replicates the functions of the kidney. However, dialysis is time-consuming and can be inconvenient in the long term. The long-term and life-saving option kidney transplant can be a choice of treatment for kidney failure for some patients.
The surgeon places a healthy kidney from a donor, after or without removing the malfunctioning kidney during an operation. The donor can be a living person who is willing to donate a kidney or a deceased person .
A kidney transplant has several advantages over dialysis, including eliminating the dependency on regular visits to the clinic, improving the quality of life, increasing lifespan, and decreasing the various dietary restrictions that a person with kidney failure may have to follow.
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How Do I Prepare For A Kidney Transplant
To get a kidney from an organ donor who has died , you must beplaced on a waiting list of the United Network for Organ Sharing .Extensive testing must be done before you can be placed on the transplantlist.
A transplant team carries out the evaluation process for a kidney. The teamincludes a transplant surgeon, a transplant nephrologist , one or moretransplant nurses, a social worker, and a psychiatrist or psychologist.Other team members may include a dietitian, a chaplain, and/or ananesthesiologist.
The evaluation includes:
Mental health evaluation. Psychological and social issues involved in organ transplantation, such as stress, financial issues, and support by family and/or significant others are assessed. These issues can greatly affect the outcome of a transplant. The same kind of evaluation is done for a living donor.
Blood tests. Blood tests are done to help find a good donor match, to check your priority on the donor list, and to help the chances that the donor organ will not be rejected.
Diagnostic tests. Diagnostic tests may be done to check your kidneys as well as your overall health status. These tests may include X-rays, ultrasound, kidney biopsy, and dental exams. Women may get a Pap test, gynecology evaluation, and a mammogram.
The transplant team will weigh all the facts from interviews, your medicalhistory, physical exam, and tests to determine your eligibility for kidneytransplantation.
These steps will happen before the transplant:
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Limit Your Exposure To Germs
Dont have a large number of houseguests during the first 6-8 weeks after surgery. Ask family members and friends who may have colds or infections to stay away. Keep preschool children at arms length, especially if they are in daycare where other children may be sick or infected. Avoid eating from salad bars as they can harbor bacteria.
What Are The Kidney Transplant Requirements
Each hospital has its own criteria for accepting people as kidney transplant recipients. But in general, candidates should have:
- End-stage renal failure and be on dialysis.
- Late-stage chronic kidney disease, approaching the need for dialysis.
- A life expectancy of at least five years.
- A full understanding of postoperative instructions and care.
What is the best age for kidney transplant?
While most kidney transplant recipients are between the ages of 45 and 65, there really is no upper age limit. However, to ensure the best results, your healthcare provider will likely look for a donor who is close to your own age.
How many kidney transplants can a person have?
In some cases, people can have two and even three or four kidney transplants in their lifetime. Your healthcare provider can tell you if this is an option for you.
What disqualifies you from getting a kidney transplant?
Kidney transplants are approved on a case-by-case basis. However, there are some general factors that could make a person ineligible for a kidney transplant, such as:
- A serious health condition that makes it dangerous to have surgery.
- Recurring infection.
- A short life expectancy.
- Drug or alcohol abuse.
No matter what your situation, your healthcare provider can determine whether a kidney transplant is a safe treatment option.
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Why Is Tissue Typing Necessary Before A Kidney Transplant
One of the first blood tests that are used to determine the tissue type of the patient and the potential donor is to check their matching and compatibility of the tissue. Each person has a different antigen on their tissues, except for identical twins.
The better the candidates the better the HLA match, as they have more chances of successful transplant over a longer period of time. As the DNA is inherited or passed down from the parents , they would have at least a 50 percent chance of matching with the child. Siblings are usually the best matches as they can be 100 percent match.
Unrelated donors are less likely to match at all, but they can also be tested. The best match is considered for the recipient when they have 12 out of 12 antigen matches with the donor, called a zero mismatch. All 12 markers could match even with an unrelated deceased donor organ if the patient has a very common HLA type.
Another blood test is to measure the antibodies to HLA. This test is conducted for the patient only and has to be frequently repeated, sometimes monthly, but it will depend upon the transplant program policy. HLA antibodies can harm the transplanted kidney. They may even increase or decrease over time, and therefore, must be measured at all stages waiting for a transplant, immediately before transplant surgery, and sometimes after the transplantation.
How Long Is Surgery To Remove A Kidney
It is possible that the treatment will take three or more hours. Simple nephrectomy vs. open kidney removal: Which is better? Which is superior? You’ll be laying on your back. Your surgeon will make an incision that is up to 12 inches 30 centimeters long. He or she will cut away part of your stomach and colon to get at your kidney. The blood vessels responsible for supplying the kidney will be tied off so that it does not bleed during removal.
Your surgeon will then lift the kidney out through this incision. To avoid hurting the nerve that runs along with the artery that supplies blood to the kidney, he or she will try to keep the vertebrae intact above and below the injured kidney. This will allow the kidney to be removed in one piece.
After surgery, the bladder will be closed with stitches or a clamp. If you do not have any other organs damaged, your surgeon will let you go home after this stage of surgery.
The hospital stay usually follows surgery. You may need blood tests and radiographs while recovering from surgery. Most patients are able to walk out of the hospital after surgery and return to normal activities within two weeks.
Nephrectomy is generally considered safe for people of all ages. However, it is important to follow your surgeon’s instructions and stay in bed rest for several days after surgery.
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How Long Does A Nephrectomy Take
This procedure is performed in the hospital while you are unconscious and without discomfort . You will be laying on your side for a simple nephrectomy or an open kidney removal. For more complex cases where both kidneys are removed, six to eight hours may be required of general anesthesia.
After surgery, you will be taken down to the recovery room for observation by nurses or doctors. The nurse will explain what happened during your operation and answer any questions you have. She will also monitor you for any post-surgical complications such as bleeding or pain. Recovery from a nephrectomy can take up to a month – depending on how many nerves were damaged during the surgery. You should try to walk as soon as possible after leaving the hospital to reduce stress on your legs and heart and help them heal faster.
Nephrectomies are very common and most people can recover quickly from this operation. However, some patients may need additional treatments to prevent disease progression or complications. If this is the case for you, your doctor may recommend follow-up visits several months after your surgery.
How Long Will I Wait For A Living Donor Kidney Transplant
If you have a donor who is willing and able to give you a kidney, you can have your transplant as soon as both you and your donor are ready. Keep in mind that being ready for transplant sometimes depends on things that are out of your control, such as other health problems in either you or your donor. Talk to your transplant team to find out if there is anything you need to do to get ready for transplant.
If you do not have a donor, you may have to wait years for a transplant. The average waiting time for a is 3 to 5 years. A kidney from a deceased donor may become available before you find a living donor. You may look for a living donor while you wait for a deceased donor kidney and have your transplant using whichever kidney is available first.
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Considering A Kidney Transplant
Your healthcare team will assess whether you are medically suitable for a kidney transplant.
To decide whether you want a transplant, it is important to understand your condition and the potential benefits and risks of the procedure. You also need to be willing to undertake the self-care that will be required for the rest of your life after the operation. Read more about the questions to ask your healthcare team.
How Can I Get More Information
A kidney transplant program will have detailed information about their evaluation process and their criteria for accepting transplant candidates. To locate a kidney transplant program closest to you please visit:
The toll-free patient services line of the Organ Procurement and Transplantation Network can provide information about the OPTN, allocation policy and other resources available to you, in both English and Spanish. Additional information is available online on the following websites:
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Living Donor Kidney Transplants
The first successful live donor kidney transplant was performed in 1954. The donor and recipient were identical twins. Since then, our understanding of donor compatibility and the development of immunosuppressant medications have greatly advanced living donor procedures. Today, approximately 75% of people who receive a kidney transplant from a living donor maintain their kidney function for 10 to 20 years.
Living donor programs allow a relative or a compatible unrelated donor to donate a kidney. Siblings have a 25% chance of being an “exact match” for a living donor and a 50% chance of being a “half-match.” Donor compatibility is established through blood tests that look for matching blood types and antigens. The overall health of the potential donor is also of critical importance.
Kidneys from perfectly matched sibling donors on average can function for over 35 years. Live donor procedures of all types, however, offer better outcomes than deceased donor procedures:
- Live donor recipients spend less time waiting for a donor organ. The wait for a deceased donor kidney in New York averages five to seven years.
- Immediately upon transplantation, 97% of live donor kidneys are fully functional, versus 50-60% of deceased donor kidneys.
- Live donor recipients face less risk of organ rejection.
What Is The Best Age For A Kidney Transplant
According to the NKF, kidney transplant is an option for people of all ages who have kidney failure, including children and older adults.
People will need to be healthy enough to receive surgery. A kidney transplant may still be a suitable option for people who are older or have certain health conditions, such as diabetes.
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What Makes Yale Medicine’s Approach To Kidney Transplants Unique
As a recognized leader in clinical research and care associated with organ transplants, Yale Medicine offers many advantages, including advanced donor-recipient matching programs, innovative transplantation techniques and exceptional expertise in long-term post-transplant care.
Our transplant surgeons perform minimally invasive kidney removal for both right and left kidneys, unlike many transplant programs that perform the left side laparoscopically while using open surgery for the right side. Our surgical experience has made the donation process very safe and far more comfortable, Dr. Kulkarni says.
Children who undergo kidney transplants by Yale Medicine transplant surgeons are admitted to an age-appropriate inpatient unit at Yale New Haven Children’s Hospital.
We are a pioneer in creating supportive communities of living donors and providing them with free, lifelong local medical monitoring for any health issues that may arise related to their organ donation.
What Are The Steps For Kidney Donor Evaluation Process
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Special Programs For Living Donor Transplantation
Many patients have relatives or non-relatives who wish to donate a kidney but are not able to because their blood type or tissue type does not match. In such cases, the donor and recipient are said to be “incompatible.”
See also: National Kidney Registry
Live Donor to Deceased Donor Waiting List Exchange
This program is a way for a living donor to benefit a loved one, even if their blood or tissue types do not match. The donor gives a kidney to another patient who has a compatible blood type and is at the top of the kidney waiting list for a “deceased donor” kidney. In exchange, that donor’s relative or friend would move to a higher position on the deceased donor waiting list, a position equal to that of the patient who received the donor’s kidney.
For example, if the donor’s kidney went to the fourth patient on the deceased donor waiting list, the recipient would move to the fourth spot on the list for his or her blood group and would receive kidney offers once at the top of the list.
Paired Exchange Kidney Transplant
This program is another way for a living donor to benefit a loved one even if their blood or tissue types do not match. A “paired exchange” allows patients who have willing but incompatible donors to “exchange” kidneys with one another-the kidneys just go to different recipients than usually expected.
That means that two kidney transplants and two donor surgeries will take place on the same day at the same time.
Blood Type Incompatible Kidney Transplant
What Are The Symptoms Of Rejection
As with any other major surgical procedure, a kidney transplant has a wide range of potential risks.
Most commonly is that the body realises that the transplanted kidney is not “its own”.
The “rejection” process can happen even in patients whose transplant kidney was match perfect in terms of blood group and tissue type.
Around 15 out of every 100 transplants will be rejected.
There are two types of ‘rejection’ – acute or chronic.
- Acute rejection: This can occur in the first few months after surgery. It causes pain and fever, but usually there are no symptoms.
- Chronic rejection: This is a long and slow reaction to the kidney transplant, but its reaction is very mild, unlike acute rejection.
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