Transplant and Hepato-Pancreato-Biliary (HPB) Institute

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   Transplant and Hepato-Pancreato-Biliary (HPB) Institute

Living Kidney Donation

Donation from a living donor provides some major advantages for individuals with kidney failure.  Donors have the additional benefit of knowing they have contributed to another person's life in a very meaningful way.

Other benefits include:

  • A kidney from a living donor generally functions immediately after transplant and therefore have better outcomes.
  • The living donor transplant can be scheduled, allowing the recipient and donor preparation time.  It also allows the recipient to optimize their medical condition.
  • There may be a reduced risk of rejection
  • Less time spent on a waiting list, which could prevent possible complications and deterioration of health

Types of Live Kidney Transplant Donors:

  1. Live related: A blood relative.
    In general, because of the genetic similarities between you and your blood relative, this may mean a lower risk of rejection and longer kidney life expectancy. There is sometimes a lower dosing of immunosuppressive medications.

    Please note that with modern immunosuppressive medications, the issue of genetic similarity is no longer as critical unless you are receiving a kidney from an identical twin or a sibling with significantly similar genetic material.

  2. Live unrelated: Non blood relative - a spouse or a friend.
    The process of donor evaluation is similar to the live related donor transplant. However, in certain occasions you may be involved in a paired exchange program, and the kidney may arrive to St. Vincent Medical Center.
Father and Son

Interested in Becoming a Living Donor?

Contact our living donor coordinator at 213-484-7498 and fill out the intake form and questionnaire.

  • Transplant Process — Living Donor

    Living donor surgery is major surgery and the possible risks can be serious, including significant bleeding, injury to adjoining organs necessitating multiple surgeries or procedures, and even death. National studies have shown that some donors have experienced kidney failure early following kidney removal, and some donors have progressed to kidney failure long term resulting in the need for kidney transplantation.

    The Living Donor program at St. Vincent has a strong, long history with no surgical complications on live donor laparoscopic surgeries as of today. It is important to address all your concerns with your Living Donor Coordinator and Donor Surgeon prior to deciding to proceed as a living donor.

    • 1. Workup Process

      The purpose of the donor medical evaluation is to make sure that donation will not pose any unusual risk to you during the procedure, or risk to your future health.  The recipient will still need to undergo the usual recipient workup.  For the donor, these tests include:

      • Simple blood test is performed to determine your blood type and that of the recipient
      • Cross-matching: Is a blood test that evaluates the compatibility, or closeness, between your tissues and the recipient's
      • Medical Evaluation
      • Surgical Evaluation
      • Psychosocial Evaluation
      • Living Donor Education
      • Financial Education
      • Lab work
      • EKG (electrocardiogram)
      • Chest X-Ray
      • 24 hour ambulatory blood pressure monitor
      • Imaging studies

      The person interested in becoming a living donor would contact our living donor coordinator at 213-484-7498 and fill out the intake form and questionnaire.

    • 2. Admission Process

      Potential live donors are seen in the Transplant Clinic for final discussion and crossmatch (compatibility with the kidney recipient) confirmation 3-5 days before their scheduled surgery.

      Both the live donor and recipient arrive early in the morning on the day of surgery to be admitted to the hospital. Before the surgery, the kidney transplant team will check the donor and recipient’s lab results to make sure they are satisfactory before proceeding with surgery. It is also possible that the recipient may need dialysis even if the recipient had dialysis the day prior to surgery. The surgeon will make this determination on the day of surgery. Arriving early to St. Vincent also allows your physician to address any last minute questions or concerns without having to cancel surgery. Early admission will assure that your surgery will still be performed that day.

      You will need to have been fasting at least 8 hours prior to your admission time. We request that you have light meals the few days prior to your admission for surgery. Once you are in the pre op area, you may need to have repeat blood work and/or x-rays, and an IV line will be placed for hydration. Your surgeon will meet with you in the pre-op area to review the surgery and answer your questions. Once everything is ready for both you and the intended recipient, you will be taken into the Operating Room.

    • 3. Surgery

      The donor nephrectomy (removal of the kidney from the donor), will be performed laparoscopically unless your doctor has discussed an open surgical procedure and/or under rare circumstances when an open conversion may be required.

      Once in the operating room, the anesthesiologist will place appropriate IV lines, monitors, and a breathing tube. This breathing tube is generally removed upon completion of surgery. A catheter will be placed in your bladder once you are asleep and will remain for a minimum of 1 or 2 days after your surgery.

      The surgery lasts approximately 1.5-3 hours. Three or four incisions, measuring less than 1/2 inch each, are made on your abdomen for the laparoscopic instruments. The team then works on separating your kidney from the adjoining organs. The final steps include application of a staple line over the blood vessels and the ureter (tube that drains the urine from your kidney). A separate 2-3 inch incision, through which the kidney is removed, is made just above your hair line over the pubic bone.

      Once your kidney is removed, it will be flushed (cleaned) with a cold preserving solution to clear the blood and prepare it for transplant into your recipient.

      All your incisions are closed with absorbing sutures which will dissolve over time. After completion of surgery, you will be awakened and transferred to the recovery room. After a short stay in the recovery room, you will be transferred to a regular hospital room where your family will be allowed to visit with you.

      laparoscopic removal
      Surgeons performing the laparoscopic removal of the donated kidney
      removal of kidney from incision
      The donated kidney will be removed from an incision in the lower abdomen
    • 4. Surgical Recovery

      What to expect after surgery

      Once you arrive to your hospital room, the assigned nurse will assess your pain level and give you pain medications. The anesthesia and/or the surgery itself may make you feel nauseated. We will do everything we can to keep you comfortable.

      The morning after surgery, you will be walking around, eating a regular diet, and have your urinary catheter removed. Most patients are ready for discharge home by the second day after surgery.

      Issues that may arise after kidney donation surgery

      Pain

      Pain is to be expected with any surgery. We will use IV and/or Patient Controlled Analgesics (PCA) for pain control. Side effects of these pain medications can include nausea and severe constipation. To help avoid these complications, we will work with you to be off IV pain medicines by the first day after surgery. You will receive oral pain medications after and at the time of discharge if you need them.

      Sore throat

      Sore throat is likely caused by the breathing tube that was placed during surgery. This usually gets better within the first 24 hours, and can be treated with over-the-counter medications if needed.

      Post-operative fever

      Almost all post-operative fevers in donors are a result of poor respiratory effort. Atelectasis is the collapse of certain portions of your lung, and can lead to pneumonia. To help prevent this, we will ask you to use an incentive spirometer to deep breathe. We will give you an incentive spirometer immediately after surgery and show you how to use it.

      Urinary retention

      While urinary retention is rarely seen, it is more common for men than women. Your nurse and our team will be regularly checking the amount of urine you are making. If we notice that there is not enough urine output and/or you cannot get any urine out, we may have to replace your urinary catheter. Urinary retention usually resolves prior to discharge.

      Serious complications

      • Bleeding requiring blood transfusion
      • Surgical complications resulting in emergency open conversion
      • Injury to adjacent organs
      • Wound infection
      • Hernia formation requiring surgical intervention

      St. Vincent is very proud of our living kidney donor program and outcomes. As of this date, no donor has stayed in the hospital longer than 3-4 days for medical reasons, and no donor has returned to the operating room for any surgical complications.

  • Transplant Process — Recipient

     

    There can be many benefits from receiving a kidney from a living donor. One of the benefits is that a living donor kidney transplant is a scheduled surgery, meaning you, your donor, and your transplant team have set the surgery date ahead of time. This allows your family members and friends to make necessary arrangements so they can be with you for surgery and recovery. Once the surgery date is set, you will receive specific instructions for the day of surgery, including what time to arrive, from the transplant team. You will also have a chance to ask questions.

    donor surgery
    Donor Surgery
    • 1. Referral

      Patients are usually referred to us by their nephrologist or their dialysis center social worker. We do accept self-referrals!

      Patients referred are either already on or are approaching dialysis. For patients not yet on dialysis but with established, moderate-to-severe renal insufficiency, our goal is to fast-track listing to avoid initiation of dialysis.

      Patients are encouraged to seek transplant evaluation as soon as diagnosed with moderate renal insufficiency. This is to establish records and plan on possible preemptive transplant if a live donor is available. In case of no potential live donor, we can assist in evaluation for listing in deceased donor kidney list.

      Referral
    • 2. Workup

      The Work up Process

      After successfully completing your initial pre-transplant evaluation, your transplant coordinator will begin scheduling appointments for testing and procedures needed prior to transplant. Some of these tests or procedures will need to be updated annually. Your transplant coordinator will notify you when a test or procedure needs to be updated. It is important to keep up with your tests and procedures so that you can be transplanted when you get the call.

      Required Testing

      • Simple blood tests including blood typing
      • EKG
      • Chest x-ray
      • Dental exam
      • Abdominal Ultrasound
      • Coronary Angiogram (for all patients over 45, diabetic, or risk factors/history of heart disease)
      • Cardiology consult (if you have risk factors, are diabetic or over age 45)
      • Colonoscopy (for all patients over the age of 50)
      • Mammogram and Pap smear for all women over the age of 40
      • Recent Prostate Specific Antigen (PSA) for all men over the age of 40
      blood tests
    • 3. Patient Selection Committee

      All patients will be presented at the Patient Selection Committee Meeting (PSC) after they have completed all their testing and have been seen by the multidisciplinary transplant team.

      The purpose of the PSC is to review the results of testing, discuss visits with the multidisciplinary team, and to determine if they qualify for placement on the transplant wait list.

      The results of the PSC discussion will be conveyed to the patient and referring physician within 10 days.

      patient selection
    • 4. Listing

      If you are approved and cleared by the multidisciplinary team in PSC, you will be added to the National Waiting List for kidney transplant. You will be placed on the waiting list based on your blood type and antibody test. If you have a live donor, you do not need to be listed on the National Wait list.

      The national organ waiting list is managed by an organization called the United Network for Organ Sharing (UNOS), a private, nonprofit agency that works with the federal government. UNOS keeps track of all the people in the United States who need kidney transplants, and matches them with donors.

      If you are not approved for listing at the time of PSC, your transplant coordinator will explain any additional testing or requirements to get you listed for transplant. On some occasions, you may not qualify for transplant. Your coordinator will explain in detail as well as send a letter to your primary doctor explaining the reasons you cannot be transplanted at this time.

      patient waiting
    • 5. Day of Transplant

      Organ Offers

      When a suitable donor is found, the surgeon and coordinator will first review donor history and testing results. If the offer is suitable for you, the surgeon will give the OK to admit you for your transplant. In some cases, the surgeon or transplant coordinator may call and discuss the organ offer with you.

      happy patient in bed

      Getting the Call

      Once you have received a call from the coordinator and you have accepted the organ offer, you will then be instructed to arrive at St Vincent as soon as possible. Please drive to St Vincent with as many important members of your family as necessary.

      Your coordinator will ask you the following questions:

      • What time did you last eat or drink anything?
      • When was your last dialysis session?
      • Have you had any recent admissions to the hospital or new health problems?
      • Have there been any changes to your life situation (ie, support, financial, or emotional states that may impact your post-transplant care?

      Once these questions have been answered, you coordinator will instruct you not to eat or drink anything and come to the hospital. If you are diabetic, please inform the coordinators so that instruction about medication dosing can be given. You should bring all current medications and a bag with a set of clothes and other essentials for hospital admission.

      Arrival to the Hospital

      We strive to proceed with transplant ASAP, however we realize there may be need for further evaluation and or need for dialysis. You will be directed to Admissions and then the floor for nursing assessment, have some additional testing done including blood work, EKG, and chest xray, and any other testing that needs to be updated since your last clinic visit. You may require dialysis prior to your transplant. The transplant surgeon will order dialysis if needed.

      On arrival to the hospital, you will be greeted by your surgeon. He will prefer to speak to you and your family members about the details of the process, including risks and benefits.

      happy patient getting phone call

      The Transplant Operation

      When everything is ready, you will be taken down to the operating room. By this time your surgeon has already prepared the organ for transplant. (Please note: on rare occasions- an imported kidney once evaluated by your surgeon may not qualify as suitable for you and thus a last minute cancellation and discharge home for a better transplant is possible. But don’t be discouraged if this happens--the intent is to assure you receive the best organ possible!)

      If the organ is suitable, you will be escorted into the preoperative waiting suite. There, the anesthesiologist will greet and evaluate you. Once complete, you are transferred to the operating room. The process of anesthesia and IV line placement can be 1-2 hours depending on your general health condition and ease at establishment of IV access. Surgery commences upon incision and is terminated upon closure of skin. Surgery time is in general 2-3 hours.

      A 6-8 inch incision is made in your lower, front abdomen, and this is where your new kidney is transplanted. The new kidney comes with blood vessels that are connected to the blood vessels that supply and drain blood in your legs. The ureter is a long tube portion of the kidney that drains urine. This tube is connected to your bladder. After sewing the ureter to your bladder, we leave a plastic tube or stent, 4 inches in diameter, and thinner than a spaghetti noodle in place. This tube assists in the healing of your bladder and is removed within 4-6 weeks of your transplant at the office under a simple office bladder camera procedure. This procedure is fairly painless and takes no more than 3 minutes.

      We do not remove your own kidneys unless there are indications to remove them. Indications for removal of your own kidneys (one or both) include: kidneys that have growths suspicious for cancer, kidneys that contain infected stones, kidneys with many cysts that frequently bleed or lead to urinary tract infections or kidneys that are too large to allow room for implantation of another kidney.

    • 6. Post-Transplant
      • Hospital Recovery

        Once surgery is complete, you are then awakened and transported to the recovery room or directly to the Intensive Care Unit (ICU), which is located on the 4th floor

        Your surgeon will have spoken to your family and they should be able to visit you within 1-2 hours of arriving at the ICU. Once your doctors consider your condition stable they will then transfer you to the 5th or 7th floor.

        In general by now you will be free from most IV lines and allowed to eat and ambulate. During surgery a catheter will be placed into your bladder to drain urine. This catheter in general is removed on post op day 3-4. On rare occasion depending on your condition- the catheter may stay longer or you may even be sent home with a catheter to have a voiding trial later at the clinic.

        By post-op day 4-5 you are ready for discharge.  Instructions include:

        • Avoiding excess water intake.
        • Avoiding any food products with high potassium.
        • Resuming diabetic diet and care if diabetic.
        • Appropriate precautions for infection control.

        Possible complications following kidney transplant include:

        • Clot in the kidney: Usually noted within the first 24-48 hours post-op, and can present with sudden abdominal pain.  The treatment for this condition is unfortunately removal of the kidney, and we are not able to salvage an organ under these circumstances.   You may in the future qualify for a second transplant.
        • Delayed Graft function: Sometimes the transplanted kidney may not function immediately, and occurs in approximately 30-50 percent of deceased donor kidneys and less than 10% of live related or non-related kidneys.  During this delay, the kidney is either making little urine or no urine at all, and you may need dialysis.  Sometimes you may be discharged home on dialysis as we monitor improvement in your kidney function over time.
        • Post-op pain
        • Post-op bleeding requiring blood transfusion
        • Infections that may include large abscesses which require wash out procedures and placement of drains.
        • Urine leakage from the bladder suture line, for which you will be taken back to surgery for an attempt at correction.
        • Hernia formation requiring surgical intervention.
        nurse and doctor talking to patient
      • Discharge from Hospital

        Going Home from Transplant

        During your admission to the hospital for kidney transplant, the transplant coordinator will meet with you and your designated caregivers to discuss and educate you about how to take care of your new kidney. A log book and manual will be given during your first teaching session.

        You will be taught to monitor for:

        • Signs and symptoms of rejection or infection
        • How to record your weight, urine output, blood pressure, heart rate, and temperature
        • The education sessions take place immediately after transplant, throughout your hospital stay, and upon discharge.

        Medications

        A transplant Pharmacist will review all of your new life-long medications to prevent rejection. All other medications you are taking will also be reviewed with you before discharge.

        If you are diabetic or require insulin injections after transplant, a diabetes educator will review your insulin regimen with you and teach you how to inject insulin if needed.


        discharged happy

        24-Hour Nursing Care

        A nurse is available 24 hours a day, 7 days per week including weekends and holidays. They can be reached at (213) 484-5551. The nurse can answer any questions you have related to transplant and call your doctors with any urgent needs.

        nursing care on call
      • The First 90 Days

        After leaving the hospital, you will follow up in the transplant clinic closely, as frequently as daily until you are stabilized. Labs are done every clinic visit in the morning before you take your medications. The transplant team will monitor your lab results, urinary output, vital signs, and incision closely to assure no complications arise.

        What to bring to your clinic visit

        • Your log book (tracks urine output, vital signs, and blood sugar if necessary)
        • Medication list
        • All your medication bottles
        • Snacks, comfort items (pillow, blanket, books, etc) while you are waiting

        At the end of your clinic visit, your transplant coordinator will review any medication changes and provide a new medication list, prescriptions and lab orders for the next visit. It may be necessary to call you at home with lab results. Keep your medication list with you and be prepared to write down any changes to your medications.

      • The First 5 Years

        Once you are more stable, you will be seen less frequently in the transplant clinic. You will need to follow up with your primary doctor and primary nephrologist 90 days after transplant and regularly after that. Your primary doctor will manage any related health issues such as high blood pressure and diabetes, and your regular annual health exam and cancer screenings. You will also need to follow up with any specialist physicians regularly such as Endocrinology and Cardiology.

        What to bring to clinic

        • Medication list
        • Any new medications or changes prescribed by another doctor
        • Any requests or orders from your primary or other doctor(s)
      • Five Years and Beyond

        Your transplant doctors will continue to watch for any signs of problems with your kidney. These can include:

        1. Chronic Rejection: this occurs when your transplanted kidney slowly stops working. Usually, this type of damage may be caused by your immune system attacking the organ. Sometimes, other issues such as high blood pressure, diabetes, high cholesterol, or high levels of immunosuppressants, or the original cause of your kidney disease, may also slowly damage your new kidney.

        2. Some of the most common symptoms of rejection include:

          • Fever
          • Decreasing urine output
          • Tenderness over the kidney
          • Elevated blood creatinine level
          • High blood pressure
          doctor looking through microscope
          A needle biopsy may be needed to find the reasons for ongoing problems with the kidney transplant. Possible treatments for chronic rejection include different types of immunosuppression, steroids, or other medications.

        3. Coronary heart disease

        4. Cancers, including skin, breast, vulvar, cervical and colon cancer

Dialysis

About Dialysis

A treatment that removes excess water and toxins from the blood for those whose kidneys who have lost the ablity to do so on their own.

There are 2 options for Dialysis.

Hemodyalisis

Uses a machine and a filter to remove the waste and water from the blood using a solution. It is done outside the body then returned to you. To get the blood into the machine, the doctor needs to make an entry into the blood vessels. This is done by joining an artery to a vein under the skin to make a bigger blood vessel called a fistula. Or a soft plastic tube can join an artery and a vein under the skin, called a graft.

hemodialysis

 

Peritoneal Dialysis

Uses a fluid (dialysate) that is placed into the abdominal cavity to remove the waste. The blood is cleaned inside your body. A catheter is placed into the abdomen to absorb the waste from the blood that passes in the abdominal cavity. The fluid is then drained away.

peritoneal dialysis

Intensive Care Unit (ICU)

What can I expect if I am in the ICU after surgery?

Patients undergoing liver kidney, and pancreas surgery may require a short stay in our ICU on the 4th floor at St. Vincent Medical Center.  This is a common and expected part of your hospital course.

What to expect immediately after surgery in the ICU

In addition to the IV in your arm, the catheter in your bladder, tube that may be placed in your stomach and small tubes that may be placed into your abdomen during surgery that were previously described, the following are some other catheters that may need to be placed prior to or during your surgery and may be in place in the ICU.

Some patients after surgery may require their breathing tube to remain in place over night while in the ICU. If this occurs, you will receive continuous medications through your IV to alleviate anxiety and control pain until we are ready to remove the breathing tube.

Nurse Adjusting Patient's Pillow

Most patients will have a small catheter, the same size as the IV in your arm, placed into an artery in either of your wrists. This catheter will allow us to monitor your blood pressure every time your heart beats and also to draw blood samples from your arterial circulation as needed.

Nurse Attaching IV Drip On Male Patient's Hand

Some patients will require the placement of a larger intravenous catheter into a vein either on the side of your neck or just below your collarbone. This catheter will allow us to give medications that cannot be given in the IV in your arm and also allows us to monitor your heart during your procedure.

If your Anesthesiologist feels it would be beneficial, you may have a small catheter called an epidural placed into your back that will give you a continuous infusion of pain medication to alleviate the pain that accompanies surgery in your abdomen.

Woman Lies with Epidural Anesthesia

Each of these procedures is done in a sterile fashion, after you receive a local anesthetic and are done inside the operating room prior to starting your surgery. Each catheter will be removed once the ICU team and surgery team agree that it is time for them to be taken out.

As an alternate method of pain control, your anesthesiologist may start you on a patient controlled analgesia pump after surgery. This pump gives pain medication through your IV in your arm and allows you to control when you receive injections of pain medication, without having to request it from the Nurse.

Female patient with IV drip needle piercing in hospital room

After surgery some patients may have a tube that goes into bladder that allows it to drain during and after surgery. Your surgery team usually removes this tube once you are up and out of bed.

Closeup Of Urine Bag

Every hour while you are awake you will be exercising your breathing using an incentive spirometer (pictured below), which is used to prevent pneumonia and is an essential part of your ICU care. Additionally your Nurse will be getting you out of bed on your first day after surgery, which is another essential component of preventing problems with your lungs after surgery.

Breathing Exercise in Hospital
Nurse next to a patient with IV tower

When can my family visit?

Visiting hours in the ICU are from 8 AM to 7 PM and then from 8 PM to 7 AM. Patients are allowed to have two visitors at the bedside at any one time, with exceptions made on a case-by-case basis. We want our patients to have restful nights of sleep, so we encourage families to go home after 830pm each night but they are welcome to call the ICU for updates at any time. We do not allow fresh flowers in the ICU, but we do encourage families to bring in any assistive devices like glasses a patient may need to increase their comfort. We also encourage the use of eyeshades and earplugs for sleep or headphones with music as needed.

Who will manage my care in the ICU?

We have a team of trained Physicians, Physician Assistants and Nurse Practitioners that are in the ICU 24/7 who will manage the minute by minute care you receive while in the ICU, while remaining in contact with your Surgeon to discuss any changes and to give updates on your progress. Additionally, our hepatobiliary surgical team will see you each day to review findings of surgery, plans for each day and when you can expect to transfer out of the ICU.

Doctor and nurse talking to a patient