Kidney Transplant

Under general anaesthesia, the surgeon makes an oblique lower-abdominal (iliac fossa) incision and dissects extraperitoneally to expose the external iliac artery and vein. The donor kidney is brought to the field on ice. The renal vein is anastomosed end-to-side to the external iliac vein, then the renal artery to the external iliac artery; clamps are released and the kidney reperfused. The donor ureter is implanted into the bladder over a double-J stent. The wound is closed in layers and a closed-suction drain may be placed.

1. 1Comprehensive transplant work-up: tissue typing, virology, cardiac and pulmonary fitness, dental review.
2. 2Listing on the national transplant registry; or directed/altruistic living-donor work-up.
3. 3Optimise dialysis and fluid balance; treat any infection or peripheral vascular disease.
4. 4Vaccinations (hepatitis B, pneumococcus, influenza, varicella) before transplantation.
5. 5Cross-match and pre-operative bloods; patient education on lifelong immunosuppression and self-monitoring.

1. 1Day 0-1: High-dependency monitoring; urine output and creatinine tracked closely.
2. 2Days 1-7: Ward-based recovery with daily ultrasound if indicated; immunosuppression initiated and adjusted.
3. 3Days 5-10: Discharge once graft function is stable, drain removed and patient self-caring.
4. 4Weeks 2-6: Twice-weekly outpatient bloods initially, decreasing as graft function stabilises.
5. 5Weeks 6-12: Double-J stent removed at cystoscopy; gradual return to work.
6. 6Lifelong: Annual review, cancer and infection surveillance, lifelong immunosuppression.