The operation
Where do you have your operation?
The transplant operation takes place in the main operating theatre on the third floor of the Royal Free Hospital. You will have a general anaesthetic and the operation usually lasts about two to three hours, although you are not likely to be back to the ward for four to five hours.
Where does the kidney go?
The transplanted kidney is placed in the right or left groin just under the skin at the front. It is placed here as it is close to your bladder and main blood vessels of your leg. The operation requires the surgeon to join up your blood vessels to those of the kidney and also join the urine tube (ureter) from the kidney to your bladder.
What happens to your own kidneys?
Your own kidneys are not removed, unless there is a reason to do so. Occasionally, we may need to use the ureter (draining tube) from one of your own kidneys to connect up your new kidney.
What tubes will I have after the operation?
- You will have a tube placed into your bladder (a urinary catheter) to measure the amount of urine your transplanted kidney is producing. It is usually removed after about a week.
- You may have a tube or two from the operation site (a drain) to remove any blood or fluid from the operation site. This is usually removed within a few days, unless it continues to drain.
- You may have a plastic tube (a stent) placed inside the urine tube (ureter) that connects the kidney to your bladder. You will not be able to see this tube after the operation, as it will be inside your kidney and bladder. This prevents any kinking of the ureter after the operation and is usually removed after four to eight weeks by a day case cystoscopy (camera to look into the bladder). If you have a peritoneal dialysis catheter, this will be removed at the same time as your cystoscopy.
- You will have a drip line in your hand and also a central line (neckline).
- You will be given control of your analgesia (painkiller). This is attached to one of your drip lines and a control button will be placed in your hand. When you press the button, you will get a painkiller that works very quickly to prevent any further pain. This is called PCA - patient controlled analgesia.
Can I eat and drink after my operation?
The operation and anaesthetic may make your stomach stop working for a while. Immediately after your transplant operation you will not be able to eat or drink but after a few hours, you should be able to start drinking sips of water. This will gradually be built up to more fluid and then a light diet. Within a couple of days you should be eating normally. The doctor will assess how much fluid you should drink every day. Remember it is often necessary to drink much more fluid than you have been used to on dialysis – it may be many litres each day. Some people may pass large amounts of urine after the transplant operation, particularly at night. This is nothing to worry about and will eventually settle down. However, it may require you to have some of your fluids through a drip.
Will the kidney work straight away?
Not always. Some kidneys will start working during the operation but some kidneys may take time to start passing urine and clearing the wastes from your body (delayed function). Roughly 90% of kidneys from live donors work straight away but about half the kidneys from cadaveric donors take time to start working. The length of time taken for the kidney to work can vary considerably. Most kidneys start working within a week or two of transplantation but occasionally, it may take months to work. During this time, you will need to continue with your dialysis. If you are on peritoneal dialysis, you may need a short period of haemodialysis.
Is it possible that my kidney may never work?
Kidney transplantation is a major operation with complex surgery required to join the blood vessels and draining tube of your new kidney to your body. Occasionally (roughly 2% of kidney transplants), the blood vessels can clot or you can bleed and compress the blood supply to the kidney. In this situation the kidney loses its blood supply and has to be removed shortly after it has been transplanted. Some kidney transplants may never work, even with good blood supply and no rejection. This happens in about 2% of kidney transplants and the kidney is usually removed after a number of months of waiting for it to start working.
Will I need dialysis after the transplant?
In most cases you will not require dialysis. Some patients may need to continue or start dialysis until their kidney works. If you are on peritoneal dialysis, you may need a short period of haemodialysis. Some patients may need a brief episode of dialysis after the operation to rebalance the level of potassium in their blood.
How long will I need to stay in hospital?
Each individual transplant is different and some patients will have to stay longer than others after the transplant. If the kidney works immediately and you recover quickly, you will only have to stay in hospital for six days. If the kidney takes time to work or the doctors feel you need more time in hospital, you may need to stay for a few weeks. Most patients are stable enough to go home after three weeks, whether their kidney has started working or not.
Will I need blood tests after my transplant?
Yes, you will need to have a number of blood tests before the transplant to make sure you are fit enough to have the transplant and to match you to the kidney. After the transplant, we will need to take blood tests at least once a day to monitor the function of the kidney, make sure there is no bleeding, check on the levels of drugs in your blood and a number of other tests. After you are sent home, we will need to do blood tests each time you come to the hospital.
Will I need any scans of my kidney?
Yes. All transplant patients will have an ultrasound scan and nuclear medicine scan of their kidney to make sure that the blood vessels are clear, the kidney is functioning well and the draining tube is not blocked. You may need more scans or X-rays after the operation to make sure the kidney is working well and there are no complications.