From the Guidelines
A kidney transplant is a surgical procedure where a healthy kidney from a donor is placed into a recipient whose kidneys have failed, with the goal of improving quality of life and reducing mortality, as evidenced by a significant reduction in mortality compared to maintenance dialysis 1. The procedure begins with the recipient being placed under general anesthesia. An incision is made in the lower abdomen, typically on the right side. The surgeon then creates a space for the new kidney, usually in the lower part of the abdomen near the hip bone.
- The donor kidney is carefully placed in this space.
- The blood vessels of the new kidney are then connected to the recipient's blood vessels, usually the iliac artery and vein.
- The ureter from the donor kidney is attached to the recipient's bladder to allow urine to flow. In most cases, the recipient's own kidneys are left in place unless they're causing complications.
- The incision is then closed with sutures or surgical staples. Immediately after surgery, the patient is closely monitored in the intensive care unit.
- Immunosuppressive medications are started to prevent rejection of the new kidney, with the introduction of calcineurin inhibitors (cyclosporine and tacrolimus) having dramatically reduced the rate of acute allograft rejection 1. The entire procedure typically takes about 3 to 4 hours. This surgical approach allows for the new kidney to quickly begin functioning, filtering blood and producing urine, often within hours of the transplant, with five-year survival rates for the graft in renal transplant patients ranging from 72% to 99% 1. The management of immunosuppressive medications and their complications is crucial, including infections, malignancies, and cardiovascular disease, as outlined in the KDIGO clinical practice guideline for the care of kidney transplant recipients 1. Ultrasound (US) is the modality of choice to evaluate renal transplants early in the postoperative period, in the posttransplant period, and also for long-term follow-up, due to its portability, lack of radiation exposure, and no need for potentially nephrotoxic iodinated contrast agents 1. Recent studies have highlighted the importance of HLA-DQ in kidney transplantation, suggesting that reevaluating human leukocyte antigen-matching priorities may improve transplant outcomes 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Pre-Transplant Procedure
- Evaluation of the patient's overall health, including potential comorbidities such as cardiovascular disease, is crucial before the transplant procedure 2, 3
- The patient's renal function, as well as other factors like serum creatinine, urea nitrogen, and electrolytes, are assessed before and after the transplant 4
Anesthesia Techniques
- General anesthesia is the conventional management of renal transplant, but regional anesthesia, such as spinal anesthesia, can be used in certain cases, especially for patients with comorbidities that make general anesthesia risky 4, 5
- The choice of anesthesia technique can affect hemodynamic stability, the use of vasopressors, and fluid therapy during the procedure 4
Surgical Approach
- The transplanted kidney is typically placed in the right retroperitoneal iliac fossa through a surgical skin incision, which can be oblique, inverted J-shaped, or paramedian 6
- Minimally invasive surgery, such as a lower transverse abdominal skin incision, can be used to improve cosmetic results without affecting postoperative renal function 6
Post-Transplant Care
- Ensuring adequate graft perfusion and normalization of volume status, electrolyte concentrations, and glycemic control are crucial in the postoperative care of kidney transplant patients 3
- Monitoring the patient's renal function and other vital signs is essential to prevent postoperative complications, such as graft dysfunction or rejection 4, 3