If you have got living donor, the nephrectomy (removal of kidney) is performed via laparoscopy technique. The left kidney is usually preferred. Once the kidney is removed, it will be flushed with preservative fluid as soon as possible, and the kidney will be cooled and kept on ice. If its deceased donor is surgically removed with other organs and transferred to the respective hospital in perfusion fluid and ice, the kidney will be examined, all clots and blood removed renal artery and vein prepared to be joined in the recipient.
kidneys are usually kept in the right iliac fossa. Donor kidneys artery is joined to recipients external/internal iliac artery. Donor’s vein is joined to recipient external iliac vein. Once joining is over recipient s blood will flow through the transplanted kidney, and filtration starts immediately in almost 95% of live donors and 60% of deceased donors. Once the kidney blood supply starts, the ureter is implanted into the bladder through an opening created and sutured. Usually, a ureteric tube (stent) is kept in the ureter to the bladder, which is removed after 4 weeks. Both donor and recipient surgeries are done under general anesthesia. Native recipient kidneys are not usually removed unless they have stones, infection, or are too big for a new kidney to accommodate.
After both donor and recipient are out of anesthesia and can breathe on their own, ventilators are removed, and recipient and donor are shifted to ICU. Both monitored in ICU for fluid balance, urine output, BP, respiration every hourly. The recipient will be continued immunosuppressive drugs.
The donor will be shifted towards in 2 days and discharged on 4-5 days. The recipient will have an ICU stay of 4 days and a subsequent ward stay of 6-7 days. The urine catheter will be removed on days 3-5. Drain tube from a surgical site that is in place to drain all the fluid or blood accumulating in the surgical site will be removed when drained fluid stops draining. Daily both will be monitored for CBC, renal functions, blood sugars in ICU and wards Will be educated on care, precautions, medication doses, diet to be followed, and follow up visits schedule and monitoring.
When the recipient's blood flows through the donor’s kidney, the defence cells of the recipients' blood recognize new kidneys as foreign cells and try to fight with them to remove them. This process will cause rejection and lead to a decline in the function of the kidney. We give drugs that will depress the immune system of the recipient so that it will not fight/ reject the new donor kidney; these medications are called immunosuppressives. Fortunately, because of the availability of potent drugs rejection rate is less than 10% and 90% of rejections are reversible. Rejection will be suspected when there is a decrease in urine output, increasing creatinine, fever, or tenderness over the kidney. Diagnosis of the rejection is proved by biopsy of transplant kidney. As you are on immunosuppressive drugs your defence power is less, and you will be prone to infections. you will be given drugs to prevent infection(prophylaxis). You should take precautions to prevent infections, like wearing a mask, hand washing. If you get fever, breathlessness, contact your transplant team immediately. Early detection of infection and treatment is important. Complete all your vaccination two weeks prior to transplant. Other early complications include a clot in the renal artery, vein, leakage of urine around the kidney, but due to improvement in surgical techniques, these complications are rare now to the tune of 3-5%.
A kidney transplant can remarkably improve the quality of life of the patients. However, there are certain practices and measures that you need to follow to live everyday life.
You may have to do frequent follow up with your nephrologist for the initial few months after the transplant. They will keep a check on the body's response to transplant and any complications which may arise. It is critical to comply with the doctor's advice and does not miss the appointments.
As our body have a tendency to reject the foreign object and organ. You may have to take immunosuppressant medicines to avoid the possibility of rejection of the organ.
Hygiene and lifestyle:
Staying active and practising good hygiene is an excellent contributory factor for recovery. Live a healthy lifestyle by engaging in any form of physical activity, eating a balanced diet, avoiding smoking, alcohol, etc.
Living healthy after a kidney transplant may require various modifications in your daily lifestyle and to avoid complications. Therefore, it is recommended that you:
Eat a healthy diet:
Prefer eating food that includes fresh fruits, vegetables, whole grains, etc. This will keep you fit and healthy.
Smoking has been linked with a high risk of cancer and various other health problems. It is important to quit smoking.
Being overweight or obese increase the risk of cancer and various other health problems. Indulge in some form of physical activity like regular exercising, yoga, etc., to ensure you stay fit and healthy.
Listen to your doctor:
Follow your doctor's advice and instruction diligently as it will not only help you to prevent infection but also help it recover soon.