Why 3 kidneys can be better than 1

[okarol]

chicagotribune.com

FROM THE MAYO CLINIC

Why 3 kidneys can be better than 1

Tribune Media Services

October 14, 2007

Q. My brother is having a kidney transplant because he has polycystic kidneys. They will add the new kidney in a different spot. His kidneys are very enlarged, but they won't be removed from his body. Why not?

A. In most cases, even for patients with polycystic kidney disease, which is a genetic disorder that causes the formation and growth of cysts in the kidneys, surgeons don't remove the person's own (native) kidneys during kidney transplantation. Instead, the surgeon usually places the new kidney in the lower abdomen. The blood vessels of the new kidney are attached to blood vessels in the lower part of the abdomen, just above the leg. The new ureter, the tube through which urine flows out of the kidney, is connected to the bladder.

In some cases, surgeons may have to remove the native kidneys. For patients with polycystic kidney disease, for example, this removal may be necessary because of significant pain or discomfort, recurrent infection, bleeding from or into the kidney cysts, or extremely large kidneys that prevent a kidney transplant. Evidently your brother's kidneys, though enlarged, do not pose this problem.

Native kidneys can be removed before transplantation, but there are several reasons we don't like to do this. First, removing the kidneys is a major operation that can require six to eight weeks of recovery. Second, if the person who needs a kidney transplant isn't already undergoing dialysis, removing the kidneys requires dialysis to begin immediately. Dialysis is an artificial way to remove waste and excess salt and fluid from your blood when your kidneys can't. Third, some people require blood transfusions either during or after kidney removal. Those transfusions can result in the development of antibodies that can attack and destroy a new kidney. If those antibodies develop, they could prevent a successful transplant.

It is possible for native kidneys to be removed after kidney transplantation if they cause problems such as the ones listed above. This often is preferable to removing them before the transplant because people tend to recover more quickly if they have a functioning kidney. Also, the risk of developing antibodies following blood transfusion is not as great after transplantation because the immunosuppressive drugs that are given to prevent rejection of the new kidney also fight the creation of antibodies.

If the kidneys must be removed after transplant, the procedure usually involves laparoscopic surgery. The surgeon inserts a tiny camera through a small incision, which allows the surgeon to see the kidney in detail. The surgeon then inserts surgical instruments through two or three additional small incisions and removes the kidneys. Laparoscopic surgery is less invasive than traditional open surgery, typically resulting in less pain after surgery, faster recovery time and less scarring.

-- Patrick Dean, MD, transplantation surgery, Mayo Clinic, Rochester, Minn.

www.chicagotribune.com/features/lifestyle/health/chi-1014_doc_r_d_hoct14,1,502740.story

[KT0930]

I have four kidneys because of having had two transplants, and they've never removed my native kidneys. I've been asked this my whole life by various people (glad I asked it when I was about 10). I was given the answer that it was major surgery, and since it was not necessary, they preferred to only do it when the native kidneys were causing problems.

[paddbear0000]

So what happens if you need a fifth or even a sixth transplant? I would think you'd eventually run out of room for the kidneys!

[angela515]

I have four kidneys because of having had two transplants, and they've never removed my native kidneys. I've been asked this my whole life by various people (glad I asked it when I was about 10). I was given the answer that it was major surgery, and since it was not necessary, they preferred to only do it when the native kidneys were causing problems.

Same exact thing for me. I have 4 kidneys, 2 transplant and 2 native kidneys. They will never remove my native's unless they cause probs. If I ever need another transplant, they will remove one of the previous transplanted kidneys.

[charee]

i have pkd and can't get on the transplant list till i get one of my kidneys removed as there is no room for a new one, i have appointment with the transplant team in December and they will give me a date for the surgery then i will be a little closer to getting on that damm list

[okarol]

i have pkd and can't get on the transplant list till i get one of my kidneys removed as there is no room for a new one, i have appointment with the transplant team in December and they will give me a date for the surgery then i will be a little closer to getting on that damm list

Hi Charee--
The native kidneys are in your back near the waist but the transplanted one goes in front, low in the abdomen, near the appendix. So why would space matter? I know they remove them as they can become uncomfortable due to PKD - are you having discomfort? Just curious.

[charee]

Hey karol i don't get much discomfort its the size of them they are 27cm about the size of a ruby league football they start at my breast bone and go all   the way  down , i look pregnant .the scans show there is no room for the new kidney at the front .its quite common to have to get one removed because of the size.

[okarol]

Thanks Charee, I didn't know they would get that big - sounds uncomfortable! 

[Meinuk]

Charee -

Can you get a second opinion?  My kidneys are 24cm & 26cm and I'm listed here in the US with no problem.

[charee]

i have had 2 surgeons look at the scans apparently i am short from my breast bone to my waist, they said if i was longer then it would be ok, hope that makes sense