Kidney Transplant Protocol
In the case of living related donors, the donor and recipient are placed in separate but adjacent operating rooms. One team is assigned to harvest the kidney from the donor while another team is preparing the recipient. In most centers the donor kidney is harvested through a traditional surgical flank incision, but other centers are now providing the option of kidney retrieval using laparoscopic technique. This results in less pain and faster recovery for the donor. Cadaveric kidneys are often harvested at distant sites, flushed and shipped on ice. This may result in a prolonged “cold ischemia time” and these kidneys often do not work for a number of days due to ischemic injury. During this time, the patient may need to be supported with dialysis.
The original anatomic site (the flank) is not used for the transplanted kidney because of technical difficulty and poor post transplant accessibility. In adults, teens, and larger children, the renal graft is placed in the recipient’s pelvis and the donor renal artery and vein are connected to the recipient’s vessels. The donor ureter is inserted through the recipient’s bladder wall and sutured in place. In small children and infants, the kidney is placed within the peritoneal cavity, which can extend from the pubic bone to the sternum.
Many centers use a non-refluxing insertion and others do not. Vesico (bladder) ureteral reflux increases the risk of infection (pylonephritis) in the renal graft.