Surgery. Patient Education Transplant Services. For a kidney/pancreas transplant

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1 Patient Education Surgery For a kidney/pancreas transplant By the time you have surgery, you may have been waiting for some time. It will help to read this section before surgery so you will know what to expect. This section covers the basics about what happens just prior to surgery and during surgery.

2 Surgery Page 9-2 Before the Surgery Your doctor or transplant coordinator will call to tell you when a donor has become available. You will be given instructions by your transplant coordinator about when to arrive and where to go. All patients will have more tests (blood tests, chest X-ray, etc.) prior to surgery. These tests include a final cross-match, which will determine whether your immune system will accept the kidney and/or pancreas. Patients who are on dialysis may need a dialysis treatment prior to surgery. The medical team will examine you and review medical records to determine what you need to have a safe operation. The nurse will give you directions about what to do before surgery. If there is time, you will be asked to take a shower and you may be given an enema. You may be given oral or IV medications to prepare you for your surgery. Once you get the final clearance to proceed with the transplant, you will be taken to the operating room.

3 Page 9-3 Surgery The Surgery You may find the operating room and the table a bit cold. We ll make an effort to keep you warm. You ll be connected to equipment that monitors body functions and systems. The anesthesiologist will put you to sleep. You will receive anesthesia by IV and through a mask placed over your nose and mouth. The anesthesiologist also places a tube in your throat (trachea) to help you breathe during surgery. A nasogastric tube (NG) may also be placed to empty your stomach. The anesthesiologist monitors you the entire time to make sure you are asleep and feeling no pain. Before the surgery is started, a central line is placed (and possibly other lines, which your doctor will tell you about, if they are needed). A central line is an IV that goes into one of the larger veins. A catheter will also be placed to help drain your bladder. The place where the doctor will make the incision and do the surgery (called the operative field) will be shaved and

4 Surgery Page 9-4 washed. Sterile drapes will be placed both to keep you warm and keep the operative field sterile. The surgery takes about 4 to 8 hours. After surgery you will go to the recovery room. You may wake up there or in your hospital room. The following pictures show where the incisions are made and how your new organ(s) is placed and connected. Abdominal Incision for a Kidney Transplant Placed either right or left, shown right.

5 Page 9-5 Surgery Abdominal Midline Incision for Pancreas or Kidney and Pancreas The Surgical Procedure for a Kidney Transplant 1. The surgeon will make an abdominal incision and expose the iliac blood vessels. 2. Next, the donor kidney will be brought into position and the donor kidney vessels will be sewn into the iliac vessels.

6 Surgery Page After blood circulation to the kidney is established, the surgeon will connect the donor ureter into your bladder. A decision will be made whether or not a ureteral stent is needed. Occasionally, a stent will be placed to support the connection of the ureter to the bladder. Kidney Transplant

7 Page 9-7 Surgery The Surgical Procedure for a Kidney and Pancreas Transplant If you are having a combined kidney and pancreas transplant: 1. The surgeon will make a mid-line abdominal incision and expose the iliac blood vessels. 2. The donor pancreas will be brought into place (usually placed on your right side) and the donor pancreas blood vessels will be sewn into the iliac vessels. 3. After blood circulation to the pancreas is established, a drainage route is created for the exocrine secretions (products of the pancreas, such as the enzyme amylase).

8 Surgery Page 9-8 a) Bladder drainage is a method where the surgeon uses a section of the donor duodenum (intestine) to bridge and collect the secretions from the pancreas. The duodenum is then connected to the bladder for drainage of the exocrine secretions. Pancreas Transplant: Bladder Drained

9 Page 9-9 Surgery b) Enteric drainage (or bowel drained) is another method to drain the pancreas secretions. A loop of your small bowel is selected and the donor duodenal bridge is sewn into the small bowel. This allows drainage of the secretions into the bowel. Pancreas Transplant: Enteric Drainage (Bowel Drained)

10 Surgery Page After the pancreas is transplanted, the surgeon will bring the donor kidney into position and proceed as previously described. While you re having surgery, your family or support person(s) may wait in the family room near the operating room or in your patient room. Your family needs to tell us where they will be waiting so we can stay in touch with them throughout your surgery. Your family will be able to speak with someone on the team in the operating room by using the phone in the waiting area. We ll let your family know as soon as the surgery is underway. The surgeon will want to talk with your family when the surgery is finished. After Surgery: You ll be taken to the recovery room. When you are ready, you ll be taken to the patient care unit. Within a few hours you may have an ultrasound to look at the blood flow into your transplanted organ(s). If you received a pancreas transplant or have heart problems, you may spend the first night after your surgery in the intensive care unit so that you

11 Page 9-11 Surgery can be monitored closely and your blood sugars can be checked often. You ll be connected to a heart monitor. You ll likely have IV insulin for the first 48 hours. Once out of surgery, you will need to breathe deeply and cough about every hour to reduce risk of respiratory complications. And, you ll have a PCA (patient controlled analgesia) pump to give yourself pain medication, as needed. You also need to walk. Walking will reduce your risk for developing blood clots, pneumonia, constipation and bloating. It will also help speed your recovery. The bladder catheter (Foley) will stay in place for about 3 to 4 days to give the sutures plenty of time to heal. If your incision has metal staples, these will be removed in 1 to 3 weeks after your surgery. If you have a stent, it will be pulled out at about 3 to 6 weeks after your surgery. Plan to be in the hospital for half a day for this non-surgical procedure.

12 Surgery Page 9-12 Questions? Your questions are important. Call your transplant coordinator during business hours. This major surgery, like all surgeries, has risks. Please discuss this with the surgeon and refer to the Benefits and Risks section of this guide Box N.E. Pacific St., Seattle, WA University of Washington Medical Center 03/2003 Rev. 01/2005