Understanding the procedure of Renal Transplantation Surgery

Renal Transplantation - Sriramakrishnahospital

Renal transplantation is a surgical procedure in which a healthy kidney from a living or deceased donor is transplanted into a person whose kidneys have failed.

The kidneys are two bean-shaped organs positioned beneath the rib cage on either side of the spine. They’re just about the size of a fist. Urine is their primary task, and it entails filtering and eliminating waste, minerals, and moisture from the bloodstream.

When your kidneys lose their ability to filter, dangerous levels of fluid and waste build up in your body, raising your blood pressure and leading to renal failure (end-stage kidney disease). When the kidneys have lost around 90% of their ability to operate normally, it is called end-stage renal disease.

Chronic kidney disease, which affects more than eight million Americans, is a significant public health concern in the United States. Patients with end-stage renal illness need dialysis treatment or a kidney transplant to live. There are currently around 340,000 dialysis patients, with 106,000 additional patients added in 2006. More than 140,000 people have a functioning kidney transplant. In the last 20 years, the prevalence of end-stage renal illness in these two groups has tripled.

Functioning of normal kidneys

The kidneys play several essential roles in keeping the body healthy. The kidneys are the organs whose functioning is essential to maintain life. The kidneys are placed on either side of the spine, behind the abdominal organs, and below the rib cage in most people.

  • Filtration of the blood to eliminate waste products from normal bodily functions, excretion of the waste as urine, and return water and chemicals to the body as needed.
  • The release of many hormones controls blood pressure.
  • The hormone erythropoietin is released to stimulate the synthesis of red blood cells.

The kidneys are two bean-shaped kidney organs that produce urine in their natural state. The bladder is a storage facility for pee. The urine is evacuated from the bladder through the urethra when the body detects that the bladder is full.

Before undergoing a renal transplant, it is essential to find a suitable donor. Tests that may be done before choosing the suitable donor include:

  • Blood Typing
  • Tissue Typing
  • Crossmatch

Types of donors that are considered for a kidney transplant

Living Donor:

A kidney donation may be requested by family members such as brothers, sisters, parents, children (18 years or older), uncles, aunts, cousins, or a spouse or close friend. This individual is referred to as a “living donor.” The donor must be in good health, have a good understanding of the transplant process, and give informed permission. Any healthy person is safe to donate a kidney.

Deceased Donor:

The Uniform Anatomical Gift Act permits anyone to give their consent to organ donation for transplantation at the time of death, as well as their family. A brain-dead donor kidney is taken from a deceased person. The kidneys are removed and preserved until a recipient is found once permission to donate is given.

Surgical Techniques before undergoing the procedure:

Living Donor Retrieval:

During both DBD and DCD retrievals, organs are retrieved similarly using cold perfusion. To restrict the exposure of the organs to warm ischemia during DCD retrieval, fast cannulation of the iliac artery with cool perfusion is undertaken. There is also a period of dissection in DBD retrievals, which permits the organs to be assessed during the procurement procedure.

The abdomen is fully exposed to the retroperitoneal area, and the bowel is mobilized to access the retroperitoneal area. The donor’s arteries and ureter(s) are identified and isolated after heparinization. The renal artery, renal vein, and ureter are then removed using an aorta patch, an IVC patch, and a ureter patch. After that, the organs are moved to the back table for further inspection and perfusion.

The nephrectomy is typically performed using a laparoscopic approach for living donor kidney transplantation. Because the left kidney has a longer renal vein, it is preferred, but no aorta or IVC patch may be used in these situations. The kidney should be flushed with preservation fluid as soon as possible after removal.

Recipient Procedure:

If the kidney is transferred from another facility, it will be preserved in perfusion fluid (in sterile bags) and surrounded by ice. The renal artery and vein should be located, flushed with preservation solution (to check for leaks), and any leaks repaired. The ureter length should be thoroughly preserved and any more surrounding fat removed.

Extraperitoneal, the graft is implanted in the iliac fossa, usually on the right side. The iliac arteries are exposed and any lymphatics found are ligated by dissecting retroperitoneally in the iliac fossa by the nephrology doctors. Between the donor renal vein and the recipient external iliac vein and between the donor renal artery and the recipient internal or external iliac artery, terminal-lateral anastomosis is done.

The kidney is reperfused through the development of a ureteroneocystostomy, and the ureter is anastomosed to the bladder. The anastomosis is done over a ureteric stent, which can be withdrawn six weeks after the transplant is completed.

You may live longer after a successful renal transplant than you would have if you were on kidney dialysis. You might also have fewer health issues and a higher quality of life.

Among the advantages are:

  • There is no need for dialysis.
  • I’m feeling more energized.
  • Improving one’s overall health
  • Having fewer dietary restrictions

Renal Transplantation - Sriamakrishnahospital

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