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Donor Nephrectomy

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  • Appropriate volunteer to donate to a person with renal failure.

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Renal Transplantation

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  • All causes of impending or established end-stage renal disease.

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Donor Nephrectomy

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Absolute

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  • Impaired renal function (generally considered to be a glomerular filtration rate < 80 mL/min per 1.73 m2).
  • Active infection.
  • Diabetes.
  • Pregnancy.
  • Age younger than 18 years.
  • Poorly controlled psychosis.

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Relative (Open or Laparoscopic)

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  • Proteinuria or hematuria.
  • History of malignancy.
  • Kidney stones.
  • Disorder requiring anticoagulation.
  • Active substance abuse.
  • Cardiovascular disease.
  • Chronic illness.
  • Hypertension.
  • Abnormal urologic anatomy.
  • Family history of diabetes.
  • History of kidney stones.
  • Obesity.

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Relative (Laparoscopic)

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  • Previous laparotomies.
  • History of pyelonephritis.
  • Horseshoe kidney.
  • Short right renal vein.
  • Multiple renal arteries.

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Renal Transplantation

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Absolute

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  • Untreated ongoing infection.
  • Active malignancy with short life expectancy.
  • Chronic illness (with life expectancy < 1 year).
  • Poorly controlled psychosis.

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Relative

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  • Cardiovascular disease.
  • Infection.
  • Active substance abuse.
  • Cerebrovascular disease.
  • Obesity.
  • Proven habitual noncompliance with medical recommendations.

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Donor Nephrectomy

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  • The patient should be in the right lateral decubitus position (for left nephrectomy) and carefully padded.
  • The operating table is flexed to extend the left flank and maximize exposure.
  • For open procedures, an oblique incision is made from a point just lateral to the lateral border of the rectus abdominus muscle and continued below the 12th rib to the paraspinous muscles posteriorly.

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Renal Transplantation

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  • The patient should be supine on the operating table.
  • The abdomen is prepared and draped in standard sterile surgical fashion.
  • A curvilinear incision is made in the left lower quadrant extending from 1 cm above the pubic symphysis to 2–4 cm lateral to the anterior superior iliac spine.

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Donor Nephrectomy

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  • Analgesia.
  • Oral intake when tolerated.

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Renal Transplantation

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  • Appropriate immunosuppression.
  • Fluid management should be adequate to ensure good diuresis without fluid overloading. Hourly urine output should be replaced with 0.45% normal saline at 1.0 mL saline per milliliter urine.
  • Monitoring of electrolytes.
  • Nothing by mouth.
  • Await resolution of ileus.
  • Kayexalate should not be given as this may cause colonic necrosis.

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Donor Nephrectomy

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  • Pneumothorax.
  • Infection.
  • Bleeding.

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Renal Transplantation

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  • Urinary obstruction.
  • Arterial or venous thrombosis.
  • Infection.
  • Ureteral anastomotic leak.
  • Bleeding.

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