Under general anesthesia, an incision is made on the right or left side of the lower abdomen just above the groin.  The surgical team places the donor kidney into the abdomen and connects the kidney’s blood vessels to the recipient’s iliac artery and vein.  The surgeons then attach the ureter directly to the bladder. The recipient’s own kidneys are not removed. The operation usually takes from two to four hours.    

After the Surgery

After surgery, patients will be transferred to a specialized floor with expertise in managing patients post transplant.  The patient can expect to feel some discomfort which can be treated with pain medication.  The patient will have an intravenous (IV) line in the arm or neck to supply nutrients, fluids and medication for the first few days after surgery.  The patient will also have a catheter in the bladder to collect measure and drain urine for a few days.  During surgery, a drain may be placed in or near the incision to drain any excess fluid.  This will be removed five to ten days after surgery.

The patient is usually out of bed and walking a day or two after surgery and is eating a normal diet within three days.

Drugs to control rejection start immediately. During the hospital stay, patients are taught about the anti-rejection medications and become knowledgeable about the warning signs of rejection. To benefit our patients, all immunosuppression therapy is customized and minimized post transplant. As soon as the patient is able, the transplant team will begin to prepare him or her for going home, usually in five to seven days.

Patients are monitored very closely by the Hahnemann University Hospital Transplant Team for the first three months after surgery.  Organ recipients must return for appointments twice a week for the first one to two months following surgery and less frequently after that. During the visits, blood tests are performed to detect early signs of rejection and any side effects from medication are addressed. 

After three months, patients return to the care of their primary nephrologist and family physician.  In addition, patients return to Hahnemann every three to six months where the Transplant Team continues to monitor their anti-rejection therapy.  

Recovery at Home

Signs of Rejection and Infection

Once the patient has been discharged, it is important to watch for signs of infections and rejection.   These include:

• a fever that continues for more than two days
• shortness of breath
• a cough that produces a yellowish or greenish substance
• a dry cough that continues for more than one week
• prolonged nausea, vomiting, or diarrhea
• an inability to take prescribed medication
• a rash or other skin changes
• unusual weakness or light-headedness
• pain, redness, tenderness or swelling at the incision site
• fluid retention/weight gain (more than 2 lbs. in 24 hours)
• vaginal discharge or itching burning
• discomfort with urination decrease in urine output
• pain during urination
• blood in the urine
• strong odor to the urine
• feeling urgent or frequent need to urinate
• exposure to mumps, measles, chicken pox, or shingles  

Guarding Against Rejection

Rejection is a complication that may occur after a transplant because the body’s immune system guards against attack by any foreign matter.  The immune system may identify a kidney transplanted from another person as “foreign” and go on the defensive to battle this invader.  To prevent this from happening, transplant patients need to take immunosuppressive medications every day.  

Regular visits to the Transplant Team at Hahnemann will ensure early detection and treatment of rejection.  

Preventing Infection  

Since immunosuppressive medications interfere with the body’s natural immune system, it is essential for kidney transplant patients to be vigilant in guarding against infection.  These precautions are vitally important:

• Wash hands often with soap and water or an antibacterial handwash.
• Keep hands away from face and mouth.
• Stay away from people with colds or other infections.
• If the patient has a wound and must change his own dressing, wash hands before and after.
• Wash hands after coughing or sneezing, and dispose of tissues immediately.
• If someone in the patient’s family becomes ill with a cold of flu, be sure that individual takes normal precautions (use separate drinking glasses, cover mouth when coughing, etc.).
• Avoid working in the soil for six months after the transplant. After that, wear gloves.
• Avoid handling animal waste and avoid contact with animals who roam outside.
• Do not clean bird cages, fish or turtle tanks, or cat litter.   If a cat litter box needs to be changed, someone other than the patient should cover it and take it out of the patient’s home before changing it.
• Avoid vaccines that involve live viruses, such as oral polio, measles, mumps, German measles, yellow fever, or smallpox. The live virus can cause infections. If a patient or any family member intends to receive any vaccinations, they should notify the transplant team or local physician.
• Maintain good dental hygiene by brushing your teeth twice daily and seeing the dentist twice a year for cleaning and checkup.        

Keeping the Patient’s Healthcare Team Informed

Communications and cooperation between the transplant team, local family physician, pharmacist, dentist and the patient is essential. The patient must be sure that each health care provider knows about the transplant, daily medications taken, and the precautions that must be followed to ensure the patient’s health.          

Coping with Emotions

Hahnemann offers counseling services to help patients cope with stressful feelings, adjust to life at home and prepare for return to work or school.  The transplant coordinator or social worker can provide information regarding these services.