why is a transplanted kidney placed in the lower abdomen

Why may I need a kidney transplant? When a patient has kidney failure, it causes him or her to feel ill. Over time, waste products and fluid build up in the body. This may result in death if untreated. There are three treatment methods for patients with End Stage Renal Disease (ESRD). The first is hemodialysis, where blood is passed through a dialysis machine and filtered in the same way as done by functioning kidneys. Another technique is peritoneal dialysis, which works by passing special fluid into the abdomen. Some of the toxic chemicals in the blood pass into the fluid. After a couple of hours the fluid is drained along with the toxins. A kidney transplant is the final means of replacing a failed kidney. When should I consider a kidney transplant? Start the transplant evaluation process when you and your nephrologist (kidney specialist) think that your kidney disease will eventually require dialysis. Begin by contacting the Dartmouth-Hitchcock transplant center and scheduling an evaluation. Before your evaluation, we will contact your nephrologist to obtain your medical records. After meeting you and reviewing several important medical tests, the transplant team will determine if you are eligible or not eligible for a kidney transplant. Is a kidney transplant the right answer for everyone? A transplant involves an operation, and requires you to take medications to stop your body from rejecting the new kidney. For some peopleвsuch as those with serious heart diseaseвthe operation and/or the side effects of the medications are too dangerous. Kidney transplantation is too hazardous for patients with conditions such as active infections and cancer. Does blood type matter for kidney transplants? The blood type of the kidney recipient and the person giving the kidneyв вmust be compatible, just as they must be for a blood transfusion. There are four blood types: A, B, AB, and O. Note: Rh (the negative or positive element of blood type) has no effect on compatibility. Will I always have to take medications after the kidney transplant? After a transplant, medications will always be needed to stop the body from rejecting the kidney. These drugs are called immunosuppressants. Because the body can reject the kidney at any time, the medications must be taken every day, for as long as the kidney works.


Where is the kidney placed? During surgery, the kidney is placed in the lower abdomen, either on the right or left side. It is connected to the blood vessels that supply blood to and from the leg. In general, your kidneys are left in place, unless they are have become very enlarged from a condition like polycystic kidney disease, or become a source of infection. How long will I be in the hospital? You will be in the hospital for 2-4 days. You may need to stay longer if a problem occurs and further treatment is needed; however, most people can go home without difficulty. How often do I have to come back after my kidney transplant? In the first month after the transplant you will return to the hospital twice a week for laboratory tests and a doctor checkup. The second month after your transplant you will come back once a week. You'll come in every month until the sixth month, and then come in once a year. For the rest of your life, you will need to get monthly lab tests done, in order to monitor your medications and check for any potential problems. How long will the tranplanted kidney work? On average, a transplanted kidney from a cadaveric (deceased) donor lasts 15 years. Some transplanted kidneys only last a few weeks, while others function normally for 20 years or more. In general, kidneys from living donors last longer than those from cadaveric donors. The key to extending the life of your kidney is taking your medications as prescribed. How long will I have to wait for a kidney transplant? Because many things can affect the wait time, it is best to check with your transplant center. Patients who can identify a living donor (who does not need to be a relative) have a significantly reduced time on the waiting list. Dartmouth-Hitchcock has some of the shortest waiting times in New England. What can I do while waiting for a kidney transplant? Go to all your routine health care visits, including dental checkups, flu shots, EKGs, stress testing, colorectal exams, mammograms and pap smears for women, and prostate exams for men. If you have a blood transfusion while on the transplant waiting list, let your transplant center know immediately. While on the list you will need to submit monthly blood samples.


If you are on hemodialysis, your dialysis center can do this for you. If you are not on dialysis we will help you arrange to have this done. Finally, you should enjoy your life, family and friends. Don't spend your days waiting by the phone!
What exactly happens when you receive a kidney transplant? While the actual process is very complex and takes a team of medical professionals Б and of course a kidney - this section will assume all of those things are in place. Here weБll take an abbreviated walk through the kidney transplant process. 1. Getting the Green Light After receiving the call from the transplant team indicating they have a kidney for you, a patient needs to get to the hospital as quickly (and safely) as possible. A suggested list of things to bring to the hospital to ensure everything goes as quickly and smoothly as possible includes a list of current medications, a list of drug allergies, health insurance information and clothing for several days. ItБs also important for a patient to stop eating and drinking as soon as they get notice a kidney is available. A patientБs stomach needs to be empty when the operation begins. 2. Arrival at the Hospital Once admitted, the patient will receive a physical exam, blood work, a chest x-ray, EKG and perhaps even other tests. While disappointing, there are some cases where surgery will be postponed and the patient will be sent home. These include: The patient has developed an infection or a medical problem that could cause problems with the surgery or recovery. The kidney being donated looks to be in bad shape or there is reason to believe it would have poor function. 3. Patient Preparation before Surgery To ensure the patient is ready for the operation, several things will be done. Hair on the chest and abdomen will be shaved, a laxative or enema may be administered to clean out the intestines and prevent constipation after surgery, and an intravenous line will be inserted to supply medicine and prevent dehydration. A sedative will also be administered to help the patient relax before surgery. There is a possibility a patient will need a transfusion of blood during the surgery. TodayБs donated blood is screened very carefully so the chance of contracting a disease from the transfusion is small.


If you have concerns about transfusions, make sure you talk to the transplant team during the time you are waiting for a kidney. 4. The Kidney Transplant The patient will be put БunderБ using a general anesthesia and will remain asleep for the duration of the surgery. Once asleep, the transplant surgeon will make an incision on the lower abdomen just above the groin. The donor kidney will be placed in the lower abdomen. The kidney's blood vessels will then be connected to the recipient's iliac artery and vein. The surgeons will then connect the ureter to the bladder. A small drain may be inserted into the abdomen to drain any excess fluid that may have accumulated during the operation. 5. After the Surgery After the surgery, the patient will be taken to the intensive care unit or acute care unit where they will be monitored by medical personnel until the anesthesia wears off and they wake up. While recovering here are some things a patient can expect: Some pain and discomfort. Medication will be provided to help relieve this. To help keep the lungs clear, a patient will be asked to cough. Fluids and medications will be delivered through IV lines in the arm or neck for the first few days after surgery. A catheter to drain urine from the bladder will be inserted. While it may feel uncomfortable and create the feeling for the need for constant urination, itБs only temporary. If a drain was inserted near the incision during surgery to help with fluid removal, it will remain there for five to 10 days. In some situations, while waiting for the donated kidney to fully recover from the procurement/transplant process, dialysis may still be used to help remove excess fluid and toxins. Patients will be monitored for laboratory results, medications, eating and exercise. As soon as the patient is able, they will be prepared for going home. What happens to my "old" kidneys? If your kidney(s) are removed during the transplant, you can donate them to a research organization to help develop treatments and a cure. If donating your kidney is something you are interested in, please talk to your transplant coordinator about this option.

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