Living Related Kidney Transplants I

Two sisters prepare for surgery on the same day. The older one is completely healthy, but her sibling, four years junior, developed kidney disease from IgA nephropathy, inflammation of the kidney. She has been on dialysis for four years, and today may be her big day: she is going to get a transplant from her big sister. After thorough screening of both siblings, the surgeons prepare to take out the kidney from the healthy sister. A hand-assisted laparoscopic procedure, the surgeon uses small ports and cameras as well as a larger port that allows a hand to help dissect out the important vascular and urologic structures. Kidney harvesting is a longer procedure than kidney transplant, and this takes us past lunchtime. My job as an anesthesiologist is to keep the kidney as hydrated and well-perfused as I can. As soon as they clamp the vessels and take out the donor kidney, they put it on ice and close up the incision. Kidneys are the most resilient organ to be transplanted, but still, once its blood supply is cut off, we're on the clock.

After bringing the donor to recovery, I go see the recipient and reassure her that her sister is doing well. We bring her back to the same room, induce general anesthesia, place an arterial and central line, and start the surgery. Even though the kidney belongs to her sister, we blunt any immunologic response by giving steroids, diphenhydramine, tylenol, and her first dose of immunosuppressants as the organ is going in. We want to do everything we can to optimize the new kidney's function and minimize the risk of rejection. We keep the blood pressures high, hydrate her fully, and measure urine carefully. At the end of the surgery, by the time we wake her up and bring her to recovery, her new kidney is making lots of urine. We hope that she won't need dialysis again for a long, long time.