Assessment, consent and the transplant operation
Derriford Hospital in Plymouth (University Hospitals Plymouth NHS Trust) is the regional centre for kidney transplantation. It provides transplant services to patients under the care of the kidney teams based at the Royal Cornwall Hospital in Truro, Derriford Hospital in Plymouth and the Royal Devon & Exeter Hospital in Exeter.
Waiting on the national list for a kidney transplant
Patients are referred for education about transplantation options usually when their kidney function, eGFR, is approximately 20. Following this, patients are required to undergo different tests to ascertain their suitability for transplantation. Their suitability is considered by their local nephrologists (kidney doctors). Transplantation is often the best treatment for patients with kidney disease. However, it is not a suitable treatment option for everybody with kidney disease. This is because there are risks associated with both the surgery and the medications used to prevent rejection and there may be other considerations. Following transplantation the initial follow up requires frequent clinic appointments. For all of these reasons it is vital that patients are carefully assessed to see if transplantation is the right treatment for them.
Every patient referred by their local kidney doctor is discussed in the weekly multidisciplinary transplant meeting. The patient is then asked to attend the Transplant Assessment Clinic. This clinic focuses on their suitability for transplantation and provides them with the opportunity to find out more about transplantation.
I would like to know a bit about the operation
Usually the donated kidney will be placed just above the crease of the groin on either side of the body. Your own kidneys usually stay where they are.
The side of the operation will be chosen by the surgeon and depends on any previous operations, the quality of your blood vessels in the groin or the length of the blood vessels on the donated kidney. The length of the scar will depend on the size of the patient, size of the kidney and depth of the blood vessels, which can be very variable.
The artery and the vein of the new kidney are joined to a large artery and vein in this area called the iliac (pronounced i-lee-ak) vessels. These vessels go on to supply the muscles of the leg and are usually very robust. Your surgeon may ask you about how far you can walk and other related questions to ascertain the quality of the blood supply. Sometimes a special ultrasound scan (called a Doppler scan) may be needed to make sure the vessels are alright.
At the time of the operation an ultrasound probe may be attached to the artery of your new kidney. You and the surgeon can then hear the pulsations in the artery of the kidney transplant. This is usually removed after a few days
The ureter (which drains urine from the kidney) from your new kidney is then attached to the bladder. Often a small plastic tube (called a stent) is inserted into the transplanted kidney through the ureter at the time of the operation to keep the join with the bladder open. Typically this is removed a few weeks later as a simple outpatient procedure.
At the end of the operation a small drain is left under the muscles, which is usually removed in three to four days. A bladder catheter will be in place and usually comes out in five days. A neck line will be inserted during the operation and will be removed after four days. This will be used to take blood from you, and to administer fluid which is important for monitoring fluid balance in the first few days.
Some surgeons might make an incision in the upper abdominal regional to get the kidney out rather than the bikini line.
What happens to my new kidney after it has been transplanted?
As soon as the blood flows through the kidney it turns a beautiful pink colour!
The start of kidney function is very variable and depends on many factors. As the kidneys recover from the effects of cold storage they gradually start working. It may be many days before this happens and it may be necessary to have dialysis in the meantime. Your doctors will keep an eye on the new kidneys function with regular blood tests.