TRANSPLANT SURGERY

WHAT IS TRANSPLANT SURGERY?

Kidney transplantation is the best treatment for patients with end‐stage kidney disease (ESKD). A kidney transplant is a surgery done to replace a diseased kidney with a healthy kidney from a donor. This type of transplant is called a living transplant. It prolongs life and increases the quality of life for the patient. The diseased kidneys are usually left in place and the transplanted kidney is placed in the lower belly on the front side of the body. People who donate a kidney can live healthy lives with one healthy kidney.

Laparoscopic Nephrectomy / Robotic Nephrectomy Within kidney transplantation, minimally invasive surgeries like laparoscopic nephrectomy and robotic nephrectomy have transformed the living donor nephrectomy operation significantly improving the outcomes. These techniques include small incisions compared to open surgery, significantly less post-operative pain, a shorter hospital stay, earlier return to work and daily activities, a more favourable cosmetic result and outcomes identical to that of open surgery.

Robotic‐assisted kidney transplantation is the latest development of minimally invasive surgery for kidney transplantation. The key differences from laparoscopic transplantation are that the laparoscopic instruments are controlled remotely from a console by the surgeon and the instruments’ design allows for an improved range of movement.

Good health with one kidney, without any complications. Kidney donation does not harm the physical strength or the life- How is a kidney transplant procedure performed?

There are two major sources of potential kidney donors:

• Living related donors: Close relatives of the patient. Eg. Parents, siblings, children, grandparents are the most potential donors. A normal individual has two kidneys and a person can easily live in style of the donor.
• Cadaver donors: A cadaver kidney is available from the individual who has been declared as brain-dead. For example, a person who expired due to an accident or stroke, the reason must be non-kidney related. In several of the cases the cadaver kidney may not be a feasible candidate for the transplantation, as firstly all the pre-screening criteria should match with the patient. In case of an unsuccessful match, the patient would have to wait further.

Suitability is initially based on two factors:

• Blood type: Your blood type (A, B, AB, or O) must be compatible with the donor’s blood type.
• HLA factors: HLA stands for human leukocyte antigen, a genetic marker located on the surface of your white blood cells. You inherit a set of three antigens from your mother and three from your father. A higher number of matching antigens increases the chance that your kidney will last for a long time. If you’re selected on the basis of the first two factors, a third is evaluated:
• Antibodies: Your immune system may produce antibodies that act specifically against something in the donor’s tissues. To see whether this is the case, a small sample of your blood will be mixed with a small sample of the donor’s blood in a tube. If no reaction occurs, you should be able to accept the kidney. Your transplant team might use the term negative cross-match to describe this lack of reaction.

Why should I have robot-assisted kidney transplantation?

We believe that robot-assisted kidney transplantation will allow you to recover more quickly and that you will experience less pain after the operation than with traditional open surgery, although this is still to be tested in large trials.

What are the possible risks of robot-assisted kidney transplantation?

There are some risks that are associated with transplant surgery, irrespective of the technique used.

Problems that can occur while you are in hospital recovering are similar to those for any major operation. These include:

• Bleeding, requiring the need for a blood transfusion or re-operation
• Injury to nearby nerves or tissues
• A chest infection
• Blood clots in your lower leg (deep vein thrombosis or DVT), which could pass to your lung
• Wound infection
• Bruising around your wounds, poor wound healing or weakness at the wound sites.