NewYork-Presbyterian. The University Hospital of Columbia and Cornell.

Transplantation

The Surgery

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Types of Kidney Transplantation

Surgeons in NewYork-Presbyterian's two kidney transplantation programs perform four kinds of kidney transplants:

Compatible live donor transplants

These are the gold standard of kidney transplant procedures. Typically the organ is donated by a relative or friend. An organ from a perfectly matched sibling donor functions for an average of 35 years, while less perfectly matched donor organs function for 20 years on average.

Preparation of a donor kidney
before transplantation.
(photo: Jada Fabrizio)

Paired donor exchanges or "swaps"

These can be performed when two transplant candidates each have a willing and medically suitable living donor, and each is immunologically or blood type incompatible with his/her donor but compatible with the other patient's living donor. While logistically complicated – requiring four transplant teams and operating rooms – patients are matched with a compatible live donor and do not have to wait for a deceased donor. Surgeons at NewYork-Presbyterian have performed paired donor transplants since 2004.

Incompatible live donors

These donors have either a different blood group from the recipient or have antigens the recipient's antibodies are designed to attack. Kidneys from these donors can be used if compatible donors cannot be found. To accept a kidney from an incompatible donor, the recipient's blood must be repeatedly "cleansed" of mismatched antibodies through plasmapheresis. Recipients must also take medications that reduce the amount of antibodies produced by their immune systems.

Deceased donor procedures

These procedures are reserved for patients who do not have a willing or medically suitable live donor. Deceased donor kidneys have a 50/50 chance of maintaining their function for 10 years post-transplant. In some cases patients with high levels of antibodies who are waiting for a deceased donor organ have these levels reduced through medications; this protocol may help to facilitate the transplantation process.

Kidney Transplantation Surgery

During the operation surgeons implant the donor kidney through an open incision in the recipient's lower abdomen, and the transplant kidney is usually placed on the right side of the abdomen. The patient's native kidneys are usually left in place, unless they have a disease such as polycystic kidney disease and experience symptoms such as pain, infection, or gastrointestinal symptoms.

The transplant surgery usually takes two to three hours; the patient then spends several hours in the recovery room. Afterward, most patients are transferred directly to the transplant unit where they remain until discharge.