Kidney Removal and Kidney Transplant Descriptions

[Hawkeye]

I am posting some info I found in case anyone was interested.  It's just some basic info about the removal and transplant procedures.


Kidney Removal
Alternative Names
nephrectomy, Definition
Kidney removal, or nephrectomy, is a surgery to remove a diseased or damaged kidney.

Who is a candidate for the procedure?
A kidney may be removed if a person:
has cancer or suspected cancer of the kidney
has severe kidney trauma, or damage from an injury
has a kidney that has poor function due to infection
is donating his or her kidney to another person who needs a kidney transplant


How is the procedure performed?
There are three basic types of kidney removal, including:
simple nephrectomy, which involves removal of just the diseased kidney
radical nephrectomy, which involves removal of the kidney, the adrenal gland above the kidney, the surrounding fatty tissue, and the lymph nodes next to the kidney. Lymph nodes, sometimes called glands, are part of the immune system. This procedure is usually done when cancer of the kidney is present.
partial nephrectomy, which involves removing only part of one kidney. This is not usually attempted unless a person has only one kidney.
A kidney removal is usually done using general anesthesia. This means that a person is put to sleep with medication and can feel no pain. The traditional type of surgery is called laparotomy. This involves making a fairly large cut into the front or side of the stomach. The ureter, which is the tube that carries urine from the kidney to the bladder, and blood vessels are cut away from the kidney. The kidney is then removed.

A kidney can also be removed using a more modern type of surgery called laparoscopy. This involves making three or more small cuts at key points on the body surface around the kidney. A pencil-sized tube with a light and camera attached to the end of it is then inserted through one cut and into the stomach. Using the camera on the end of the tube, the inside of the stomach can be seen. The surgeon uses other thin tools that are inserted through the other small cuts to free the kidney. The kidney is then removed through a slightly larger cut in the stomach.

What happens right after the procedure?
After surgery, the person will be taken to the surgery recovery room. He or she is watched closely for a short time. The blood pressure, pulse, and breathing rate will be checked often. A urinary catheter will be in place when the person wakes up. This is a tube that drains the urine from the bladder. The urine will be pink colored after the surgery due to mild bleeding. When the person can urinate on their own, the catheter is removed. A tube may be left in the skin incision to drain any blood or fluid from the surgery.

Pain is common after surgery, and pain medications are given as needed. The person will be taken to a hospital room to recover once the anesthesia has worn off. The person will gradually be allowed to eat, starting with a liquid diet 1 to 3 days after surgery.

What happens later at home?
A person having a kidney removal usually needs a 5 to 7 day hospital stay. The recovery time depends partly on the person's age, the type of surgery done, other health problems, and any complications. A person who has had a laparoscopy often recovers faster than someone who has had a laparotomy. Pain medications are often needed for a few days at home. The person is allowed to slowly increase his or her activity level and diet.

What are the potential complications after the procedure?
Surgery poses a risk of bleeding, infection, and allergic reaction to anesthesia.

If both kidneys are removed or the remaining kidney does not function well, dialysis or a kidney transplant may be needed. Dialysis is a procedure to filter the blood. It is often needed three times a week for life or until a kidney transplant can be obtained.

 
Author: Gail Hendrickson, RN, BS
Date Written: 07/19/00
Reviewer: Melinda Ratini, DO, MS
Date Reviewed: 01/16/04





Kidney Transplant
Alternative Names
renal transplant, transplantation of the kidney, Definition
Kidney transplantation involves placing a healthy donor kidney into a person whose own kidneys have stopped working. The donor kidney can either come from someone who has died or from a living donor.

Who is a candidate for the procedure?
Only people who have complete and irreversible kidney failure are candidates for this procedure. The most common causes of kidney failure are:
diabetes
glomerulonephritis, which is an inflammation of the filtering cells of the kidney
polycystic kidney disease, which is a condition that causes cysts throughout the kidney
high blood pressures
pyelonephritis, an infection of the kidney
There are a few conditions that would rule out a transplant entirely. These include:
cancer within the past 5 years
infections such as tuberculosis or osteomyelitis, which is an infection of the bones
severe heart, lung, or liver problems
Once a person is deemed suitable as a transplant candidate, a donor must be found. The best situation is for the donor kidney to come from a living family member or close friend.

If no suitable living donor can be found, the person can be placed on a national waiting list for a kidney from someone who has died. There are currently over 44,000 patients awaiting kidneys in the US. Waiting time can be several years.

How is the procedure performed?
The kidney is removed from the living donor in an operating room after the person is put to sleep with anesthesia. If the donor is dead, the kidney is removed at the same time that many other organs are being removed for transplantation.

The recipient of the kidney transplant is put to sleep with anesthesia. An incision is made in the lower part of one side of the abdomen. The blood vessels of the donor kidney must be connected to the corresponding vessels in the recipient's pelvis. Blood flow is restored to the donor kidney. The ureter, which is the tubular part of the kidney that carries urine, is connected to the recipient's bladder. There is usually room for the donor kidney to be implanted without having to remove the patient's original kidneys. When all the connections have been made, the incision is closed.

What happens right after the procedure?
The hospital stay for a donor is about 2 to 3 days. Recovery after the operation is usually uneventful. The person will have a bladder catheter that is put in place during the surgery. This is usually removed after the first day. The individual is usually up and around within 24 hours. He or she can resume eating as soon as the anesthesia wears off.

The kidney recipient needs to stay in the hospital from 3 to 7 days. A bladder catheter is inserted during the surgery. It can usually be removed by the second day after the operation. The recipient can generally resume eating within 24 hours. He or she should be able to get out of bed and walk as soon as the anesthesia wears off.

The recipient of the new organ needs to take drugs to suppress the immune system and prevent the body from rejecting the new kidney. These are started either immediately before or during the transplant procedure. The patient is monitored carefully during the first week or two to determine the proper dosages.

What happens later at home?
The donor and the recipient can expect a similar recovery.
Walking is encouraged to prevent lung complications and to restore strength.
Heavy lifting and straining should be avoided for 4 to 6 weeks.
Driving is permitted once the person's incision is pain free.
Sexual activity can be resumed when the person is comfortable.


What are the potential complications after the procedure?
There are several potential complications:
infection, which happens in roughly 25% of transplant recipients.
major bleeding, which may require a blood transfusion.
problems with the blood vessel connections between the donor kidney and the recipient's pelvic vessels.
clot in the artery or vein supplying blood to the kidney. If this happens, the kidney may die.
narrowing of the artery within the kidney. This is known as transplant renal artery stenosis. This can limit blood flow to the kidney. It also makes it difficult to keep blood pressure under control. Most of the time, the narrowed segment can be expanded using a small balloon that is inflated where the narrowing is.
leaky ureter connections to the bladder. This problem is treated by inserting a stent. A stent is a very thin, straw-like tube that provides a kind of scaffolding around which tissues can heal.
kidney rejection. The body's normal immune response to the new kidney is to reject it. Drugs to suppress the immune system prevent rejection in most cases.
cancer. Between 6% and 8% of transplant recipients develop cancer as a complication of the drugs that suppress the immune system.
For the most part, kidney transplantation has very good results. Kidney transplant recipients live longer, healthier lives than is possible with dialysis treatments. Although there is a greater short-term risk of death associated with the transplant surgery, this risk is outweighed by the long-term effects of continuous dialysis. Depending on the source and quality of the donor kidney, a successful outcome for kidney transplant can be expected 85% to 95% of the time. A kidney transplant can last an average of 8 to 25 years.

Outcomes for living kidney donors are excellent. The risk of death from kidney donation is less than 4 in 10,000. There are almost no long-term risks. Living kidney donors do not need to undergo any special medical testing, maintain any special diet, or take any medications as a result of kidney donation.

 
Author: Robert Merion, MD
Date Written: 02/14/00
Reviewer: Melinda Ratini, DO, MS
Date Reviewed: 01/16/04
 

 
EDITED: Fixed spelling mistake in SUBJECT line. Changed 'tensplant' to 'transplant'  Please use spellcheck - bajanne2000/Moderator

[coravh]

One added comment about the laparascopic nephrectomy. The incisions are not necessarily around the kidney. The kidneys are at the back, and the surgery is performed from the front (at least in my cousin's case). She has one larger incision (about the size across of her fist) and 2 smaller ones about 1 - 2 inches across. These are all on her abdomen.

Maybe the procedure isn't done the same everywhere.

Cora

EDITED: Fixed spelling mistake in SUBJECT line.  - bajanne2000/Moderator

[angieskidney]

wow very good post! Do you mind if I use that on my site?

[Hawkeye]

wow very good post! Do you mind if I use that on my site?

I took it from a medical website to post here, that's why I left the author information at the bottom to give proper credit.  The information is provided there for all to use.  Just make sure to keep the author information to avoid legal issues.

[Hawkeye]

EDITED: Fixed spelling mistake in SUBJECT line. Changed 'tensplant' to 'transplant'  Please use spellcheck - bajanne2000/Moderator

I don't believe spellcheck checks the subject line, but I will be more careful in the future.

[Bajanne]

Along with editing, I should have told you how much I appreciated that very helpful information that you have given to us.  This website is built on that kind of sharing.  Thank you again.

[Hawkeye]

Along with editing, I should have told you how much I appreciated that very helpful information that you have given to us.  This website is built on that kind of sharing.  Thank you again.

Your welcome, and don't worry about it.  You have a job to do here as a mod., I understand completely.

[ahamner]

Here is some interesting news.

New Transplant Method Can Boost Kidney Acceptance
Patients Receive Chemotherapy and Bone Marrow in Lieu of Taking Powerful, Often Debilitating Anti-Rejection Drugs
By BARBARA PINTO

July 27, 2006 — - At the sound of her coach's whistle, Jennifer Searl launched from the platform into the pool. She was swimming time trials while training for a triathlon, no small achievement considering that until recently Searl could barely walk, let alone swim.

"When I was in college I had to have a handicapped permit because it was too painful to walk," said Searl, now 26.

After undergoing a kidney transplant at age 13 because of kidney disease, she had to take powerful drugs, 25 pills a day, to prevent her body from rejecting the new organ. The drugs, she said, were far worse than the transplant surgery and left her with painful warts on her legs and feet, weakened bones and cataracts.

Even with the medication, Searl's body eventually rejected the kidney.

For her second transplant at age 22, she opted for an experimental treatment that would allow her body to tolerate the new organ without drugs.

Doctors began by using radiation and chemotherapy to weaken Searl's immune system. Then she received both a kidney and bone marrow to regenerate a new, compatible immune system from her donor -- her mother.

"We essentially fool the immune system into thinking the donor's organ is part of one's own body," said Dr. David Sachs, who pioneered the surgery at Massachusetts General Hospital.

'It's Been Just a Blessing'

The new kidney transplant procedure eradicates the need for those debilitating anti-rejection drugs that can cost up to $12,000 a year. That type of tolerance has been a long-standing goal for patients and surgeons.

"Tolerance, by definition, means the transplant is being accepted without the need for immunosuppression, and that is the holy grail," said Dr. Benedict Cosimi, a transplant surgeon.

While the procedure using chemotherapy and radiation promises to make patients' lives easier in the long run, there is significant risk upfront. Days before and weeks after the surgery, patients must remain in isolation, because they are vulnerable to dangerous, even deadly infections.

For 24-year-old Christopher McMahon, the fatigue and pain lasted for weeks.

"It's an awful thing to go through," he said. "But the rewards were so great, it kept me going."

McMahon is one of 10 patients who have successfully undergone the new procedure. Four years after his surgery, he is off all medication.

"It's been just a blessing," McMahon said. "I love not having to get up in the morning to have my daily regimen of medicine."

Searl agreed, saying the risk of this procedure is worthwhile for the outcome she now enjoys.

"How I'd like to describe a conventional transplant? I say it's a treatment not a cure. And I feel like this is a cure," she said.

Doctors say this approach, used only in kidney transplants so far, could mean a drug-free life for other organ recipients in the not-too-distant future.

Copyright © 2006 ABC News Internet Ventures

[Hawkeye]

WOW  , that sounds fantastic.  Hopefully it is all they say it is, because that sounds like a really incredable improvement over current procedures.  Lets hope those first patients continue to do well and more surgeons start using this procedure if they do continue to do well.