KTP (KIDNEY TRANSPLANT)
At Sarvodaya Hospital, we offer all kinds of related kidney transplants, including an advanced ABO Incompatible Kidney Transplant procedure (transplant without a blood type match).
Kidney transplant is a procedure where one kidney from a live or cadveric donor is harvested and implanted in a patient who is suffering from chronic kidney disease requiring some form of dialysis.
Pre-emptive renal transplant
It is a transplant done in a patient who is on the verge of receiving dialysis. Such patients are straightaway taken for renal transplant instead of first being subjected to dialysis and then transplanting them.
PROCEDURES & SURGERIES
BEFORE RENAL TRANSPLANT
A thorough donor workup is done before transplant to ensure donor safety after kidney donation. All attempts are made to ensure donor safety and longevity for rest of donor’s life.Also, tissue matching is done to ensure that the donated kidney is well accepted by the recipient and chances of rejection are minimized.
AFTER THE PROCEDURE IN THE HOSPITAL
After the surgery you will be taken to the recovery room for observation. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to the Transplant intensive care unit (ICU). Kidney transplantation usually requires an in-hospital stay of seven days.
After renal transplant, patient usually starts making urine immediately on operating table. However, in few cases of cadaveric transplant, urine formation may be delayed and till the time, adequate urine formation starts, patient may require dialysis support.
You will have a urinary catheter to drain your urine which is removed by 5th to 6th day post transplant. Aninternal DJ stent is placed in your transplanted kidney during surgery which is removed 1 month post surgery.
You will receive IV fluids until you are able to take in adequate food and fluids.
Your immunosuppression (anti-rejection) medications will be closely monitored to make sure you are receiving the optimum dose and the best combination of medications.
Blood samples will be taken frequently to monitor the status of the new kidney, as well as other body functions, such as the liver, lungs, and blood system.
Your diet will be gradually advanced from liquids to more solid foods as tolerated. you are encouraged to eat all kind of healthy food without much restriction.
You may begin physical activity by second day after the procedure. You should get out of bed and move around several times a day.
Nurses, pharmacists, dietitians, physical therapists, and other members of the transplant team will teach you how to take care of yourself once you are discharged from the hospital.
Once you are home, it is important to keep the surgical area clean and dry. Your physician will give you specific bathing instructions. The stitches or surgical staples will be removed by 14th day during a follow-up office visit.
Notify your physician to report any of the following:
- Fever, which may be a sign of rejection or infection
- Redness, swelling, or bleeding or other drainage from the incision site
- Increase in pain around the incision site, which may be a sign of rejection or infection
Fever and tenderness over the kidney, decreased urine output and swelling in feet and around eyes are some of the most common symptoms of rejection.Acute rejection most commonly occur 6 months post transplant which may require hospitalization and kidney allograft biopsy. An elevation of your blood creatinine level (blood test to measure kidney function) and/or blood pressure (monitored by your physician) may also indicate rejection. The symptoms of rejection may resemble other medical conditions or problems. Consult your transplant team with any concerns you have. Frequent visits to and contact with the transplant team are essential.
Your physician may give you additional or alternate instructions after the procedure, depending on your particular situation.
DURING THE PROCEDURE
Kidney transplantation requires a stay in a hospital. Procedures may vary depending on your condition and your physician’s practices.
Generally, a kidney transplant follows this process:
- An intravenous (IV) line will be started in your arm or hand. Additional catheters may be inserted in your neck and wrist to monitor the status of your heart and blood pressure, as well as for obtaining blood samples. Alternate sites for the additional catheters include the subclavian (under the collarbone) area and the groin.
- A catheter will be inserted into your bladder.
- You will be positioned on the operating table, lying on your back.
- Kidney transplant surgery will be performed while you are asleep under general anesthesia. A tube will be inserted through your mouth into your lungs. The tube will be attached to a ventilator that will breathe for you during the procedure.
- The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
- The skin over the surgical site will be cleansed with an antiseptic solution.
- The physician will make a long incision into the lower abdomen on one side.
- The physician will visually inspect the donor kidney prior to implanting it.
- The donor kidney will be placed into the abdomen. A left donor kidney will be implanted on your right side; a right donor kidney will be implanted on your left side. This allows the ureter to be accessed easily for connection to your bladder.
- The renal artery and vein of the donor kidney will be sutured (sewn) to the external iliac artery and vein.
- After the artery and vein are attached, the blood flow through these vessels will be checked for bleeding at the suture lines.
- The donor ureter (the tube that drains urine from the kidney) will be connected to your bladder.
- The incision will be closed with stitches or surgical staples.
- A drain may be placed in the incision site to reduce swelling.
- A sterile bandage/dressing will be applied.
HOW THE TRANSPLANT WILL PROCEED
The following steps will precede the transplant:
- Your physician will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
- You will be asked to sign a consent form that gives your permission to do the surgery. Read the form carefully and ask questions if something is not clear.
- If you have been on routine dialysis before the procedure, you will receive dialysis prior to the procedure.
- For a planned living transplant, you should fast for eight hours before the operation, generally after midnight. In the case of a cadaver organ transplant, you should begin to fast once you are notified that a kidney has become available.
- You may receive a sedative prior to the procedure to help you relax.
- Based upon your medical condition, your physician may request other specific preparation.
INVESTIGATIONS BEFORE TRANSPLANT
- Blood tests: Blood tests are performed to help determine a good donor match, to assess your priority on the donor list, and to help improve the chances that the donor organ will not be rejected.
- Diagnostic tests: Diagnostic tests may be performed to assess your kidneys as well as your overall health status. These tests may include X-rays, ultrasound procedures, kidney biopsy, and dental examinations. Women may receive a Pap test, gynecology evaluation, and a mammogram.
- The transplant team will consider all information from interviews, your medical history, physical examination, and diagnostic tests in determining your eligibility for kidney transplantation. The potential donor must have a compatible blood type and be in good health. A psychological test will be conducted to ensure the donor is comfortable with the decision.
HOW DO THE KIDNEYS WORK?
The body takes nutrients from food and converts them to energy. After the body has taken the food that it needs, waste products are left behind in the bowel and in the blood.
The kidneys and urinary system keep chemicals, such as potassium and sodium, and water in balance, and remove certain waste products from the blood. They are produced when foods containing protein, such as meat, poultry, and certain vegetables, are broken down in the body. They are carried in the bloodstream to the kidneys. Kidneys also regulate fluid and acid-base balance in the body.
Two kidneys, a pair of purplish-brown organs nearly the size of your fist, are located below the ribs toward the middle of the back. Their function is to:
- Remove liquid waste from the blood in the form of urine
- Keep a stable balance of salts and other substances in the blood
- Produce erythropoietin, a hormone that aids the formation of red blood cells
- Regulate blood pressure
- Produce vitamin D and maintain bone and muscle health
The kidneys remove waste products from the blood through tiny filtering units called nephrons. Each nephron consists of a ball formed of small blood capillaries, called a glomerulus where filtration takes place, and a small tube called a renal tubule.
Waste products, together with water and electrolytes and acids, forms the urine as it passes through the nephrons and down the renal tubules of the kidney.