Surgery: What to Expect
Kidney transplant surgery requires approximately three hours. The kidney is implanted into blood vessels in the pelvis through a curved incision in the lower abdomen. The native kidneys are not usually removed. The new kidney is surgically connected or anastomosed to the iliac artery and the iliac vein, located in the pelvis. The ureter of the new kidney is then implanted into the bladder.
The new kidney often starts functioning immediately and there is no need for further dialysis. Occasionally, the new kidney does not function immediately and dialysis is required until the kidney starts to function properly. If the kidney is not immediately creating urine after the surgery, the transplant team will initiate a series of tests to perform surveillance of the kidney until it functions. These tests may include an ultrasound, renal scan or biopsy. Immunosuppressive medications are started immediately after kidney transplantation. The Montefiore Einstein Center for Transplantation features a dedicated pharmacist who assists the team in monitoring medications and also helps educate patients prior to discharge.
Comprehensive Postsurgical Care
After surgery, most patients are transported to the Post-Anesthesia Care Unit (PACU) for recovery from anesthesia. After several hours in the PACU, patients are moved to the transplant floor for further care. If the doctors recommend more aggressive monitoring or surveillance, patients may be transferred instead to an intensive care unit.
Patients are seen twice each day by attending transplant doctors. Most patients stay in the hospital from five to 10 days after transplantation, depending on their condition. An extensive discharge education program and a multidisciplinary care plan ensure that medications are ordered, dosages are correct, follow-up visits are arranged and home conditions are suitable for the patient. Most patients are walking without assistance and eating regular food when they go home. After discharge, patients are seen in the outpatient office within a week, where post-transplant coordinators offer additional instruction.
Following the kidney transplant, all patients take medications called immunosuppressants to prevent the body's natural reaction to reject the kidney. These medications must be taken every day for as long as the kidney functions. As immunosuppressive medications can cause side effects, the transplant team will work closely with the patient for the rest of his or her life to watch for any side effects and will adjust medications accordingly.
We individualize immunosuppressive medications based on the patient's condition. Initially, patients are on seven to eight medications after transplant, but by the end of the first year most patients require only two to three medications for the transplant and can have a normal, functional life at home with minimal restriction on activities. Some patients can even be withdrawn completely from steroids, which are associated with many side effects after transplantation.
During the first month following the procedure, patients return to the Montefiore Einstein Center for Transplantation twice a week for laboratory tests and a checkup. During the second month, patients return once a week and eventually once every other week or monthly. About half of our patients require readmission in the first year, usually to investigate fever or a change in lab test results. Overall, the survival rate at the Montefiore Einstein Center for Transplantation is more than 90 percent in the first year.