Chapter 30. Renal Transplantation

Donor Nephrectomy

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

Renal Transplantation

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

Donor Nephrectomy

Absolute

• 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.

Relative (Open or Laparoscopic)

• 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.

Relative (Laparoscopic)

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

Renal Transplantation

Absolute

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

Relative

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

Donor Nephrectomy

• 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.

Renal Transplantation

• 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.

Donor Nephrectomy

• Analgesia.
• Oral intake when tolerated.

Renal Transplantation

• 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.

Donor Nephrectomy

• Pneumothorax.
• Infection.
• Bleeding.

Renal Transplantation

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