Kidney Transplant

Initial patient evaluation with the transplant team

The team reviews in detail the patient's medical history and current physical condition. The patient will meet the transplant team, including the:

• Transplant surgeon, who examines the patient and discusses the transplant procedure.
• Transplant physician, who reviews the patient's medical history and performs a complete examination to identify conditions which may complicate a future transplant, such as heart disease.
• Transplant coordinator, who tells the patient about the process of getting listed for a donated organ, and about the medications the patient will need after the transplant.
• Dietitian, who discusses dietary restrictions before surgery with the patient, and suggests changes to the diet after successful surgery.
• Social worker, who helps the patient use support resources before and after the transplant.
• Transplant ethical committee examines and evaluates the whole case including both recipients and donors and issues permission for transplantation in accordance with organ transplant act.

Medical tests

In order to determine if the patient is a good candidate for a transplant, the transplant team will ask the patient's primary care physician (family doctor) to order several medical tests. These tests will identify any conditions that might cause problems during the transplant surgery, and help make sure that a transplant is the best treatment option.

Listing for transplant

Based on the evaluation and medical tests, the transplant team will decide if the patient is to be placed on the list for transplantation surgery.

Identifying a donor

There are two sources of donated kidneys: those from living donors and those from patients who have died (cadaveric donors). Kidneys from living donors provide the longest lifespan for both the patient and the kidney. Such kidneys can come from a living relative (brother, sister, parent, etc.), or from a living person not related by blood to the person who will receive the transplant (such as a spouse, adoptive parent ).

Transplant waiting list

If it is not possible to arrange for a living donor, the patient is placed on the waiting list for a cadaveric donated kidney. While waiting for a cadaveric donated organ, a patient must:

• Stay as fit as possible
• Go to all routine health care visits, including dental checkups, flu shots, EKGs, stress testing, colorectal exams, mammograms and pap smears for women, and prostate exams for men.
• Let the transplant center know immediately if the patient has a blood transfusion
• Submit monthly blood samples. If the patient is on hemodialysis, the dialysis center can do this.
• Let the transplant center know of any changes to the patient's address or phone number
• Let the transplant center know of any changes in the patient's health status

Surgery

• Living donor: The date and time of the operation is coordinated with the patient and donor. The patient comes to the hospital on the morning of the operation. The patient is prepared for surgery in the same day surgery center, and will begin taking immunosuppressant medications. The patient is then taken to the operating room for the transplant.
• Cadaveric donor: Patients waiting for a cadaveric donor will be contacted once a kidney becomes available. The transplant coordinator will call, make sure the patient is in good health, and tell the patient what time to arrive at the hospital. Upon arrival, the patient will be examined and will begin taking immunosuppressant medications. The patient is then taken to the operating room for the transplant.

Hospital stay

For a kidney transplant, the patient will be in the hospital for a minimum of three days.

Clinic visits

At discharge from the hospital, the patient will receive an appointment card for a follow-up clinic visit. This is usually for the third day after discharge from the hospital. At this first visit, the transplant team will take some lab tests to track the patient's progress and find any potential problems.

The patient will have regular clinic visits for at least six months. After that time, the patient will return to his or her endocrinologist for regular care.

For patients undergoing living donation, the date and time of your operation will be coordinated with you and your donor.

You will come to the hospital on the morning of your operation. We ask that you do not eat anything after midnight and take your medicines with only a sip of water. Next, you will be prepared for your surgery in our same day surgery centre and will begin taking immunosuppression medications. You will then be taken to the operating room for your transplant.

For those patients waiting for a cadaveric donor, you will be contacted once a kidney becomes available. The transplant coordinator will call you, make sure you are in good health, and tell you what time to arrive at the hospital. You should have nothing to eat or drink until your transplant. Upon arrival, you will be examined and will begin taking your immunosuppressant medications.

Regardless of the donor type, the kidney transplant operation is the same. First, the recipient is placed under general anaesthesia. When the patient is safely asleep, the transplant surgeon makes an incision on the right or left side of the lower abdomen, just above the groin.

The surgical team will then place the donor kidney into the abdomen and connect the kidney's blood vessels to the recipient's iliac artery and vein, which supply the leg. The surgeons will then connect the ureter (the duct that carries urine) to the bladder. A Foley catheter in the bladder is also used to drain urine and allow the bladder to heal. The surgeon may place a small tube (a stent) within the ureter to insure proper healing. This stent is removed two weeks after surgery by a urologist. In addition, a small drain, called a tube drain is occasionally placed into the abdominal cavity to drain any excess fluid.

You will be in the hospital for a minimum of three days. You may need to stay longer if a problem occurs and further treatment is needed. You can eat on the day after surgery and you will be expected to walk around on the same day. You will be discharged when you can eat and drink, your pain is well controlled with pain pills, and the kidney is functioning well.

Once your transplant surgery is over and the initial anxiety of caring for your new kidney subsides, you should resume as many of your normal activities as possible.

Use the following links to learn more about precautions you need to take after kidney transplant surgery:

• Precautions
  In general, you can participate in the activities that you did before your transplant. However, you will need to take some extra precautions.
• At home
  After surgery, you must routinely do some things at home to check for the first signs of any problem.
• Your Medications
  The key to the success of your transplant is to take your medications exactly as prescribed.
• Clinic visits
  At these regular visits, you can meet with any member of your transplant team. The visits usually last about thirty minutes.

Kidney transplantation has become one of the mainstays in management of CRF and the success of such procedure has come a long way in imparting a near normal life to such patients.