The day is coming
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The day is coming
If you are on a transplant list you should be always localizable. At the time of the call you will be informed of the existence of a potential donor compatible with you and the possibility of receiving a transplant. You will also be notified if you go as first receiver or how reserve.
You should go to the hospital as soon as possible:
- Grab your basic belongings.
- Keep calm.
- Listen carefully to the directions of the doctor who is calling you.
- Don't drive.
- If possible come with you.
Preoperative
When you arrive at the TR Unit (UTR), you will be informed of when you made the last HD session (in case you are in a substitute program), in case it was necessary to do one before the TR.
Before entering the operating room, they will perform a series of tests:
- general analytics.
- Thorax RX.
- ECG
- visit anesthesia.
- peripheral channeling.
Crossmatch
It is performed before any TR and consists of mixing recipient's blood with donor cells, to check for circulating cytotoxic antibodies, which would destroy living donor cells, which could trigger hyperacute rejection.
If this blood does not destroy the donor's cells, the crossmatch is negative, the transplant can be performed. If the crossmatch is positive, the transplant cannot be performed.
The recipient should know that at any time before the intervention the TR can be suspended:
- for positive crossmatch.
- have doctors say that there is not a lot of guarantee of suitability.
- so that the organ is not valid due to some extraction problem.
- if you are "reservation".
The intervention
The intervention lasts about 3-4 hours on average. In a first TR, the damaged kidneys are not removed, and the new kidney (right iliac fossa) is added. If removal of the diseased kidney is necessary, the graft will be located in the usual area of the organ.
Postoperative
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Postoperative
After the surgery you will go to the UTR, where there will be qualified medical and nursing staff, with professional experience in this specialty.
When you wake up from anesthesia:
- It will be monitored (FR, FC, PA and Tª).
- You will have a VP for EV medication administration.
- He will carry a SV for strict urine control - quantity and appearance.
- Drain carrier near the surgical wound that will be removed in a few days.
- Your new kidney may not work immediately and may require dialysis until it is properly functioning.
After 24 hours of the intervention, you can get out of bed and start solid intake. Once transplanted the capacity to generate urine is restored and the analytical values will be normalized. In the immediate postoperative period, periodic urine and blood tests are performed to check for proper functioning of the new kidney.
In certain cases, the nephrologist may request complementary examinations:
- RX
- ultrasounds
- kidney biopsies
- isotope tests
Immunosuppressive medication is key to the success of TR, in some cases initiating before TR and adjusting individually after TR.
Most patients after two weeks without complications can be discharged and begin the necessary outpatient monitoring. You will need to strictly follow the directions provided by the medical and nursing team, and know the importance of strictly following immunosuppressive treatment.
Postoperative complications
Rejection
Inflammatory response of the recipient's organism to the transplanted organ. The transplanted organ is recognized as foreign, with certain immunosuppressants delimiting the recipient's body's ability to attack and destroy those elements that are foreign to it.
Type of rejection:
- Hyper-sharp: in the operating table
- Acute: especially during the first three months post-transplant although it may appear at any time.
- Chronic: Lifetime of graft (slow and irreversible deterioration of renal function)
Infections
Immunosuppressive drugs may promote opportunistic infections because these patients have weakened defenses
Elevation of the PA
diabetes
Urological complications
The house
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The house
When you leave, you become fully responsible for following the TR guidelines. You will need to bring your discharge report to your GP, to report on the process and the medication you are taking. You will also receive directions on upcoming medical and analytical controls.
Every day you must write down:
- Fasting weight
- Temperature.
- Diuresis.
- If you are a carrier of FAVI or peritoneal catheter, you should follow the same care as when you were on dialysis.
- In case of any doubt consult with your nephrologist or TR nurse.
How to prepare a house after a transplant
- Ventilate the house without you inside (prevent drafts).
- Avoid being in contact with someone at home if you suffer from a contagious disease (if necessary use a mask).
- Avoid smoking and do not stay near people who are smoking.
Prevention against infection
- Wash your hands often.
- Avoid people with colds or other infections.
- If you have any wounds you should wash your hands before and after care.
- Avoid contact with animals, especially strangers, when possible.
- Do not clean cages or fish tanks.
- Avoid live virus vaccines.
- Brushing teeth after each meal.
Controls after transplantation
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Controls after transplantation
At first they will be very frequent but over time, and depending on their condition will be spaced. He was re-elected blood and urine tests to check your general condition, medication levels and kidney function. Additional tests such as ultrasounds or nuclear medicine tests in order to objectify how your kidney works.
If your kidney is suspected of not working properly or there may be rejection, you may be asked for one renal biopsy.
It may appear diabetes, due to the medication you are taking, and may be irreversible and you need insulin for life.
In case you are a carrier of FAV, surgical closure will only be indicated if it is excessively dilated or causes blood circulation problems. If you are a carrier of peritoneal catheter / hemodialysis catheter this will be removed after a few months, and you will maintain the same care and hygiene measures.
Blood pressure (BP) checks will be done to prevent hypertension. Elevated BP is common in the transplanted patient, sometimes it is a side effect of some medication or the patient is hypertensive before the transplant. In any case, your doctor will adjust your treatment.
Una blood pressure greater than 140-150 / 90-95 mmHg is a negative element for the transplanted organ, it is recommended:
- low salt diet,
- avoid obesity,
- avoid sedentary lifestyle and stress,
- quit smoking, alcohol and stimulants.
Main reasons for consultation
- Fever of 38, or fever (37º - 38º) of more than two days.
- Cough with sputum.
- Dry cough of more than a week of evolution.
- Nausea, vomiting and / or diarrhea.
- You cannot take the prescribed medication orally (vomiting).
- Breathing difficulty.
- Intolerance to prescribed medication, doubts about the doses to be taken.
- Rash or skin problems.
- Discomfort when urinating or the presence of blood in the urine
- Decreased amount of urine.
- Pain or discomfort in the area of the surgical wound.
- Weakness or dizziness.
- Fluid retention, presence of edema.
- Elevation of PA maintained.
- Changes in your health.
- Need to take some medicine that your transplant doctor has not sent you (painkiller ...).
- Modification of your usual treatment by a doctor who is not a transplant.
Guide in Catalan
Guide in Spanish