Kidney transplant: placement and surgical connections
In a kidney transplant, a donor kidney (a healthy kidney from another person) is usually placed in the lower abdomen and joined to the patient's blood vessels and bladder.
Remember
A donor kidney is usually added in the lower abdomen rather than swapped in for a failed kidney, and the patient's own kidneys are usually left in place. In the usual operation, its artery and vein are joined to the iliac vessels (the large artery and vein that carry blood to and from the leg) and its ureter (the tube that carries urine from the kidney) is joined to the bladder.
A kidney transplant is for a patient whose own kidneys have little or no function. A healthy kidney from another person (the donor) is placed in that patient. It is usually put in the lower abdomen, on the right or left side near the groin, in the iliac fossa (the shallow hollow on the inner surface of the hip bone, low on one side of the abdomen).
The new kidney is usually added alongside the patient's own kidneys rather than replacing them. Those kidneys are usually left in place and are removed only if there is a specific reason, such as infection.
The surgeon makes three joins. Each surgical join between two tubes is an anastomosis. In the usual adult operation, the artery and vein of the new kidney are sewn to the iliac vessels (the large artery and vein that carry blood to and from the leg). Its ureter (the tube that carries urine from the kidney) is usually attached to the bladder. When blood is allowed to flow through the joins, the new kidney filters it and urine drains into the bladder.
The patient needs immunosuppressant medicines (drugs that dampen the immune system) because the immune system still attacks a donor kidney. They are needed for the rest of the patient's life. Taking out the patient's own kidneys does not prevent this attack.
Key facts
- Site
- usually the lower abdomen, in the iliac fossa near the groin, on the right or left side.
- Blood supply
- in the usual operation, the artery and vein of the new kidney are joined to the iliac vessels.
- Urine drainage
- in the usual operation, the ureter is joined to the bladder.
- Own kidneys
- usually left in place, and removed only if they cause problems such as pain or infection.
- Heterotopic and orthotopic placement
- heterotopic means placed in a different position from the original organ, and is the usual arrangement; orthotopic means placed in the original position, an alternative when the usual iliac fossa approach is not feasible.
- Long term
- immunosuppressant medicines are needed for the rest of the patient's life.
Exam traps
- Removing the failing kidneys is not a routine part of a transplant, because they are usually left in place and are taken out only if there is a specific reason, such as infection. The donor kidney is also usually placed low in the abdomen, not high.
- A donor kidney is not usually joined to the renal artery and vein that supply the failing kidneys, which are usually left in place. Nearby iliac vessels are used for the joins instead.
- Joining a donor kidney's artery to the aorta and its vein to the inferior vena cava is used in small children. The usual adult operation uses the iliac vessels instead.
Read the full notes
Tested in 6 SimpleMed+ questions
Practice it in Urinary System, with the answer and a full explanation after every question.
Practice these questions