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 are like first receiver as reserve.
You should contact the hospital as soon as possible:
- Grab your basic belongings.
- Keep calm.
- Listen carefully to the directions of the calling physician.
- Don't drive.
- If possible, be accompanied.
When you arrive at the TR Unit (UTR), you will be informed of when the last HD session was performed (if you are in substitution program), in case it is necessary to do one before the TR.
Before entering the operating room, they will perform a series of tests:
- general analytics
- RX thorax
- visit anesthesia
- peripheral channeling
It is performed before any RT and involves mixing blood from the recipient with donor cells, in order to check for circulating cytotoxic antibodies, which would destroy the donor's living cells, which could trigger hyperacute rejection.
If this blood does not destroy the donor cells, the crossmatch is negative and 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 may be suspended:
- by positive crossmatch
- because the doctors consider that there is not too much guarantee of suitability
- so that the organ is not valid due to some problem in the extraction
- if you are "reservation"
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.
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:
- Will be monitored (FR, FC, PA and Tª)
- She will have a VP for EV medication administration.
- You will have an 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 you may need dialysis until it works properly.
After 24 hours of the intervention, you can get out of bed and start solid intake. Once transplanted, the ability 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 additional examinations:
- kidney biopsies
- isotope testing
The immunosuppressive medication is key to the success of the TR, in some cases it is started before the TR and adjusted individually after the TR.
Most patients, after two weeks without complications, can be discharged and begin the necessary outpatient check-ups. You must strictly follow the instructions given by the medical and nursing team, and know the importance of strictly following immunosuppressive treatment.
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.
Types of rejections:
- Hyper-sharp: on the operating table.
- Acute: especially during the first three months after transplantation, although it may appear at any time.
- Chronic: throughout the life of the graft (slow and irreversible deterioration of renal function).
Immunosuppressive drugs can promote the onset of opportunistic infections, as these patients have diminished defenses.
Elevation of the PA
When you leave, you become fully responsible for following the TR guidelines. You must send the discharge report to your GP, to inform him of the process and the medication you are taking. You will also receive directions on upcoming medical and analytical controls.
On a daily basis you should note:
- Fasting weight.
- 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 the house after a transplant
- Ventilate the house without you inside (prevent air currents).
- Avoid contact with someone at home if you have a contagious disease (if necessary use a mask).
- Avoid smoking and do not stay with people who are smoking.
Prevention against infection
- Wash your hands often
- Avoid people with colds or other infections
- If you have any injuries you should wash your hands before and after the cure
- Avoid contact with animals, especially strangers, when possible
- Do not clean cages or fish tanks
- Avoid live virus vaccines
- Tooth brushing after each meal
Checks after transplantation
At first they will be very frequent but with time, and depending on their state they will expand. You will be done blood and urine tests to check your general condition, medication levels and kidney function. Further tests such as ultrasounds or nuclear medicine tests in order to objectify how your kidney works.
If you suspect your kidney is malfunctioning or rejected, you may be asked for one renal biopsy.
It may appear diabetes because of the medication you take, and it may be irreversible and you need insulin for life.
In case you are a carrier of FAVI, surgical closure will only be indicated if it is excessively dilated or causes problems with blood circulation. In case of being carrier of peritoneal catheter / hemodialysis catheter it will be retired after a few months, and you will maintain the same hygiene measures and measures.
Controls will be made of the blood pressure (PA) to prevent hypertension. Elevated BP is common in the transplant patient, sometimes
as a side effect of any medication or that the patient is hypertensive before the transplant. In any case, your doctor will adapt your treatment.
A voltage 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 life and stress
- give up tobacco, alcohol and stimulants.
Main reasons for inquiry
- Fever of 38º, or fever (37º-38º) of more than two days.
- Cough with expectoration.
- Dry cough more than a week of evolution.
- Nausea, vomiting and / or diarrhea.
- You cannot take the prescribed medication orally (vomiting).
- Respiratory difficulty.
- Intolerance to the prescribed medication, doubts with the doses to take.
- 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, edema.
- Maintained increase in PA.
- Changes in your state of health
- Need to take any medication that your transplant doctor has not sent (pain reliever, among others).
Modification of your usual treatment by a non-transplant doctor.