As touched on in the last article, at some point in the hours leading up to the procedure, your transplant surgeon will ask you to sign a consent form. This is an important document that in essence validates to the transplant surgeon that we have your permission and that you are willing to undergo the operation. In the form, the surgeon documents the risks and complications that are associated with a kidney transplant and talks to you about them. This can be quite scary but of course, these are potential eventualities, and it is our duty to give you all the facts and to make sure you know about and understand them. 

Before being wheeled down to theatre, the nurses on the ward will give you pre-medications (pre-meds). These include drugs such as steroids and immunosuppressants to reduce the risk of rejection. Each transplant centre will have a slightly different protocol for which drugs they give you. You will also have antibiotics to reduce the risk of infection after the surgery. When you get to theatre, you will first be wheeled into the anaesthetic room. The anaesthetist will explain what they are doing and will very gently put you to sleep, this is normally a straightforward process. Once you are asleep, they will place ‘lines’ into a vein and artery to enable monitoring and to give you fluid and medication during the procedure. The time spent in the anaesthetic room is about half an hour. You’ll then be wheeled into the operating theatre and all members of the team including anaesthetists, surgeons and theatre scrub staff will collectively introduce themselves and go through a checklist to make sure that everyone knows exactly the operation we are doing and any potential problems to look out for. This is called the WHO pre-operative checklist and we do this before every single operation. 

So now the operation can start! A kidney transplant normally takes between two and three hours with a minimum of two operating surgeons. The operation is different in each person due to their specific anatomy and of course, this might be a second, third, or even fourth kidney and there might be other surgical nuances that slightly changes the way we approach the operation. Typically, we make an incision just above the groin on the right. We push the bowels aside to create access to the large blood vessels that sit right at the back of your abdomen and pelvis and supply blood to your lower limbs. This will be the kidney’s new home; we don’t take out your original kidneys as many think. 

We then connect (by sewing with fine sutures) the renal vein to the iliac vein, and the renal artery to the iliac artery. This is highly intricate, high-end surgery and every stitch is crucial. Sometimes there are multiple arteries and veins to connect, each case is different. After the blood vessel connections have all been done, we open the clamps and blood flows through the kidney. This is a magical moment. We then attach the ureter, which takes urine from your new kidney to the bladder, to allow for the excretion of urine as normal. We place a tube called a ‘ureteric stent’ into the ureter and bladder to ensure a good flow of urine in the first few weeks. 

We then sew the different layers of your abdominal wall back up and in the skin you would normally have a neat suture that lies just under the skin. 

You will wake up in the recovery room. Although there might be some pain you would have been given lots of painkillers. You will have a catheter going up into the bladder and IV lines coming out of your neck and hand. In some departments you might have an ultrasound scan of your new kidney in the recovery room. After the operation many patients feel a little bit groggy - this is quite normal and passes after a few hours. Once you’re back on the ward after two to three hours, usually you can eat and drink unless instructed otherwise. 

Sometimes the kidney starts to work straight away, and this is brilliant. However, in many cases and for lots of different reasons the kidney doesn’t work straight off, and this is known as ‘delayed graft function’. We don’t worry so much about this; as long as there is a good blood supply to the kidney, we wait patiently and invariably urine will start to come, it might be hours or days later, but you’ll have extremely close contact with your transplant surgeon and physician who will explain everything on a day-to-day basis. Your kidney function will be measured daily. Every so often if we are worried about the kidney or for example there is some bleeding, we might take you back to Theatre to sort these issues out.  

If all goes according to plan and of course this depends on the age of the recipient and other factors, you might only have to stay in hospital for five to seven days. If there are complications or a need for more monitoring, then this might be longer. Overall, a kidney transplant in the UK is a very successful procedure and hopefully brings about a new lease of life for the recipient. 

I think it is improper to write any article about deceased donor transplantation without sparing a thought for the phenomenally brave and generous organ donors and their families who ultimately make this all happen. I look forward to the next edition of Kidney Life where I discuss what to expect in the longer term after having a kidney transplant. 

Jeremy Crane 

Jeremy Crane MD FRCS (vasc)

Consultant transplant and vascular surgeon at the Hammersmith Hospital West London 

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