Como é a cirurgia do transplante?

#renaltransplant, #kidneytransplant, #renalsurgery If you need, you can choose the SUBTITLES. It was dawn when Gilmar received the longed-for phone call. Gilmar, a potential deceased donor has appeared for you! The doctor even asked a few questions to make sure that Gilmar was fine at the time, was not treating any infections and had not received a blood transfusion recently. Thus, he was instructed to remain fasting and wait for the result of the cross match test. The cross match test is the test during which Gilmar's blood is crossed, that is, placed in contact with material from the deceased donor to observe the test that takes place within a few hours. Negative cross match means that Gilmar's blood does not have antibodies against the donor and, therefore, can receive the kidney. And Gilmar overcame the immune barrier: his cross match was negative! Congratulations, one of the donor's kidneys will be destined for you, Gilmar! He immediately goes to the hospital where he is going to have a kidney transplant, performs new tests to make sure whether hemodialysis session is necessary or not just before surgery. It is a race against time because once the deceased donor's kidneys are removed, the kidneys are preserved in a cold solution until the moment of transplantation. The time they stay out of the body is known as cold ischemia time. Although the cold ischemia time is at most 48 hours for the kidneys, efforts are made to shorten this time. Because the shorter the cold ischemia time, the greater the chance of the kidney working and the greater its survival. After 8 hours of fasting and satisfactory test results and obtaining the signature of the consent form for the surgery, Gilmar is sent to the operating room. He then receives general anesthesia and other medications. The surgery begins with an oblique opening in the skin with a scalpel in the lower part of the belly close to the right or left groin depending on the team's assessment. After cutting the skin, the fatty tissue is incised followed by an incision of the muscular fascia and sheath. After such incisions, the peritoneum, the membrane that lines the abdominal cavity, with its contents is removed and access to the bladder and the vessels that descend into the leg (the so-called iliac vessels) is gained. The kidney is removed from the ice, which is then placed in the best possible position on the surgical bed. Then, 3 anastomoses are performed. Anastomosis? That's right, anastomosis is the union between two structures by means of a surgical seam. First, the donor kidney vein is anastomosed with Gilmar's iliac vein. Second, the donor kidney artery is anastomosed with Gilmar's iliac artery. Now the kidney is ready to receive Gilmar's blood. And so the kidney gains color and gets warm! And to conclude, the third anastomosis is performed, which is the union of the ureter of the donated kidney with Gilmar's bladder. Thus, the path through which the newly formed urine through the blood filtration will travel is established. Then the surgical wound is closed during which a drain is placed to allow fluid to drain in the next 2-3 days. A probe is also placed in the bladder through the urethra to allow monitoring of the amount of urine and relieving pressure from inside the bladder. Such a probe is removed after 5 days of surgery. Here is a curiosity, the sick kidneys are not removed. Except in rare cases when the kidneys are very large as in polycystic kidney disease. Gilmar now has 3 kidneys: 2 non-functioning native kidneys and 1 functioning transplanted kidney. Gilmar's surgery ended and lasted about 2 hours. He was then taken to a recovery room and 1h later he was transferred to an infirmary bed. The success of the kidney transplant depends on the conditions of the patient and the donor and the experience of the surgical team. Hospital stay can vary from 7 to 21 days. During this period, drug adjustments, monitoring of possible complications and some hemodialysis sessions may be necessary until the new kidney awakens and takes over the work of the sick kidneys. The functioning of the new kidney can last 10 to 15 years on average. Gilmar spent 5 years waiting for a kidney. And now he will enjoy many years free from dialysis, it is as if he had gone back in time before kidney failure. But this time with greater responsibility and commitment as he will have to adhere to immunosuppressive treatment to allow the transplant kidney to be accepted and will have to undergo periodic consultations to prevent and treat complications.