Open kidney transplantation is the most common type of renal replacement surgery. This procedure is performed on patients who have failed kidneys for at least 15 years and are not candidates for dialysis. Open kidney transplantation is also the most common way to replace a kidney after a deceased donor has expired. In a recent study, more than a hundred patients were treated with this procedure, and the success rate was 92. But how do you decide whether an open kidney transplant is right for you? Here are some of the benefits and risks of this surgery.
The United Network for Organ Sharing (UNOS) manages the nation’s transplant system and started a new allocation system in 2014. They wanted to make the system more efficient, while not changing the parts of the system that are already working well. This new system is designed to increase the chance that patients will receive a kidney, provide longer function after a transplant, and reduce the waiting time for some groups. However, there are still some groups that are hard to match with most kidneys.
In the first year after the transplant, one in three recipients will experience acute rejection. This condition usually occurs without any symptoms, but if they do develop, the doctor can help them by using powerful immunosuppressants. Immunosuppressants prevent the body’s immune system from attacking the new kidney. The immune system attacks the transplanted kidney, causing it to fail. These drugs usually have to be taken long-term to prevent rejection.
Another technique that has benefited open kidney transplantation is a minimally invasive approach. The Vattikuti-Medanta technique, for example, pioneered the use of regional hypothermia in open kidney transplantation to decrease the amount of warm ischemia time. This technique uses modified Toomey syringes to inject ice-slush into the abdominal cavity around the kidney. This allowed the surgeon to perform robotically without requiring a large incision.
While both groups experienced some complications, their outcomes were similar at three and four years posttransplantation. The rates of postoperative haematuria, peri-operative graft thrombosis, and wound infection were similar between groups. The OKT group had a higher transfusion rate and a higher rate of postoperative haematuria, but postoperative creatinine evolution was similar. Incisional hernia, seroma formation, and uretero-neocystototomy were higher in the OKT group.
While open kidney transplantation is the most common form of renal replacement, laparoscopic nephrectomy is also a viable option for patients who have failed the procedure before. During the laparoscopic kidney transplantation procedure, the donor kidney is perfused with a cold solution before positioning it in the operative field. The donor kidney is wrapped in icy slush-filled gauze and marked at the anterior aspect for orientation. The grafted kidney is delivered using a GelPOINT device, which positions the kidney lateral to the right external iliac artery. The implanted kidney is then retroperitonealized through the abdominal cavity.
One major limitation of this study is the limited number of patients in each group. The study was not random and the sample size was small, so results may not be generalizable to other centers. The study’s long-term outcomes should not be interpreted with haste, because the two groups have similar incidence of graft failure. A similarity in the number of grafts may be a result of differences in the distribution of comorbid conditions.