Kidney Transplantation Procedure
Kidney disease is one of the major public health issues in the United States as the number of people suffering from this condition has tripled in the last two decades. Given the increase in the number of people suffering from kidney disease, the treatment of this condition has become critical in improving the quality of life for end-stage patients. According to Barry (2016), kidney transplantation is the most suitable treatment for patients with end-stage renal disease (ESRD). It is the most commonly performed solid organ transplant process and has developed to include the process of continued quality improvement. Over the past few years, kidney transplantation has evolved to include a systematic team approach with a focus on improving patients quality of life. This paper examines the preoperative and postoperative procedures in kidney transplantation based on anatomy and physiology.
Kidney transplantation procedure begins by selecting a donor from two different sources i.e. a living donor or a deceased donor. Living donors must be individuals in excellent health with the ability to give informed consent after being well informed about the transplantation. Such donors could include family members, close friends, or other individuals willing to donate their kidneys. On the other hand, a deceased donor is an individual who has suffered brain death. Such individuals can give consent for the use of their kidneys in transplantation at the time of death. In addition, their family members can give such consent or permission as well. After such consent is given, the kidneys are removed and stored until a recipient is identified (Ascher, Chandran & DiPaola, 2015). When identifying a donor, donor imaging is carried out to evaluate the renal size, anatomic abnormalities, vascular variations, relative function, and associated pathologies (Barry, 2016). In some cases, a computerized axial tomography scan is carried out. The main objective of donor imaging is to leave the living donor with a better kidney. In addition to donor imaging, other tests are conducted as part of the transplant evaluation process. These tests include blood type testing, tissue typing, crossmatch, and serology. These blood tests are carried out to identify the type of blood and tissue present and to help match a donor kidney to the recipient.
The next stage in this process is recipient preparation, which is carried out to identify any existing contraindications, risk of recurrent renal disease, and immunologic risk factors (Barry, 2016). This stage of the preoperative kidney transplantation process helps to identify unsuitable anatomy for the technical success of the transplantation. A pre-transplant urinary tract evaluation is carried out during recipient preparation to answer questions relating to the status of the bladder and its substitute, the presence of cancer, and the size of the kidneys. Recipient preparation also entails conducting different kinds of tests such as general health maintenance, cardiovascular assessment, and pulmonary evaluation. These tests help to ensure the safety of the operation and to determine the patients ability to withstand the anti-rejection drugs necessary after the kidney transplantation procedure.
Kidney Transplant Surgery
The second major phase of kidney transplantation is transplant surgery, which is carried out under general anesthesia and takes between 2-4 hours. Open and laparoscopy are the most commonly used surgical procedures for kidney transplantation. Ascher, Chandran & DiPaola (2015) states that laparoscopy is increasingly used over open surgery. Kidney transplant surgery generally involves placing the donor kidney in the patients lower abdomen. The blood vessels of the new (donor) kidney are attached to the blood vessels of the lower part of the recipients abdomen i.e. just above his/her legs. The urine tube (ureter) of the donor or new kidney is attached to the bladder. Open kidney transplant surgery is mostly carried out using an oblique muscle-cutting incision (Rutherford Morison) or the pararectal incision (Alexandre /hockey stick) (Hameed et al., 2018). For appropriate exposure, an incision of between 15 and 20 cm is made during open kidney transplantation. However, an open kidney transplant surgery usually involves a 5-7 inch incision on the side, cutting of the muscle, and removal to the twelfth rib tip. Similar to laparoscopy kidney surgery, open kidney transplantation does not involve the removal of the original kidneys unless they are greatly enlarged or cause severe health problems like frequent kidney infections and uncontrollable high blood pressure. Recovery in a hospital following an open kidney transplant surgery usually averages 4-5 days.
Laparoscopic kidney surgery represents a major advance in renal transplantation involving a living donor. The advancement of this technique was fueled by the fact that living donors prefer smaller incisions that lessen the cutting of muscles. As this technique has continued to advance, it is carried out in different forms including a purely laparoscopic technique, retroperitoneal kidney transplant surgery, hand-assisted, and robot-assisted technique (Hameed et al., 2018). As noted by Ascher, Chandran & DiPaola (2015), a laparoscopic kidney transplant involves small incisions and a thin scope with a camera to view inside the individuals body. The procedure also involves the use of wand-like instruments for kidney removal. The procedure is better than open kidney transplant surgery as it lessens the need for strong pain drugs, short recovery time, low complication rate, and quicker resumption of normal activities.
Aftercare is an important part of the recovery process from kidney transplantation process. According to Luo (2018), postoperative operations are carried out to monitor the patients vital signs and ensure he/she is awake and stable. Post-kidney transplant period usually requires close evaluation of kidney function as a means of enhancing the patients stability and his/her wellbeing. During the postoperative process, the patient is monitored to identify any early signs of rejection and adjustments to the different drugs. A critical part of the postoperative process is the observation of the probable incidence of immunosuppression-related effects like cancer and infections (Ascher, Chandran & DiPaola, 2015). Postoperative procedures are essential in kidney transplantation because the body can fight off the transplanted organ since it is a foreign object. The body is likely to fight off the foreign organ as it fights off viruses and bacteria that cause illness.
Postoperative procedures in kidney transplantation are also carried out to help manage or deal with complications related to the transplant process. Some of the potential complications of kidney transplantation include bleeding, blood clots, rejection of the transplanted organ, infection, heart attack or stroke, and tube leakage or blockage. To help in the management of complications, postoperative procedures involve administering anti-rejection medications. Some of the medications administered by physicians include anti-inflammatory drugs, anti-proliferative medications, antilymphocyte drugs, and cytokine inhibitors. Patients are given a checkup and follow-up schedule to monitor the functioning of the new kidney.
In conclusion, kidney transplantation is a complex procedure that is carried out in different stages i.e. preoperative, kidney transplant surgery, and post-operative procedures. Each of these stages has different procedures that are geared toward enhancing the well-being and health of patients. As evident in this discussion, the process can generate some complications, which are mostly managed using anti-rejection medications. Over the past few years, laparoscopic kidney transplant has emerged as the most common surgical procedure for kidney transplantation.
Ascher, N.L., Chandran, S. & DiPaol, M.E. (2015). Kidney transplant. Retrieved from University of California San Francisco website: https://transplantsurgery.ucsf.edu/conditions–procedures/kidney-transplant.aspx
Barry, J.M. (2016). Renal transplantation. Indian Journal of Urology, 32(3), 175-177.
Hameed, A.M., Yao, J., Allen, R., Hawthorne, W.J., Pleass, H.C. & Lau, H. (2018). The evolution of kidney transplantation surgery into the robotic era and its prospects for obese recipients. Transplantation, 102(10), 1650 1665.
Luo, E.K. (2018). Kidney transplant. Retrieved May 14, 2022, from https://www.healthline.com/health/kidney-transplant
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