Potential Complications

Potential Complications

Donor nephrectomy surgery for transplant is a major operation.  As such, there are number of potential risks and complications inherent in a procedure such as this.  Some of them are outlined below:

Intraoperative Issues

The kidney is located very close to the heart and therefore both gives a lot of blood to return to the heart as well as takes in a lot of blood fresh from each heartbeat.  The kidney artery and vein are connected directly to the Aorta and the Inferior Vena Cava respectively and these are the vessels which will be controlled and clamped off when the kidney is removed from the body.  If there are any issues with the dissection, control or clamping of these vessels, varying degrees of internal bleeding may result which may then result in conversion to an open approach (if initially started laparoscopic), or further open surgery in order to stop the bleeding.

Bleeding can also be encountered at any point during the dissection and mobilization of organs and tissues on the way to get to the kidney in the initial phases of the operation and can result in the same outcomes as above.

Organ Injury
The kidney lies in the back part of the body, hidden by the ribcage, the spine, and the overlying organs such as the liver, colon, small bowel on the right and the colon, small bowel, spleen, pancreas and stomach on the left. A kidney donor operation usually goes from front to back, therefore all the overlying organs must be mobilized in order to expose the kidney and get it ready to be removed.  If, during the course of this work, an organ gets inadvertently injured, this may result in additional procedures in order to fix the problem and repair the affected organ, or even separate operations to fix the issue following a period of observation under a separate anesthetic.  This organ injuries could take the form of bowel injury, stomach injury, splenic laceration, liver laceration, etc.

Conversion to Open
Over 95% of donor nephrectomy operations are conducted via a Minimally Invasive Surgical (MIS) approach called laparoscopy in which several small 1 cm incisions are made in the abdomen to allow ports to be placed, through which the operation is conducted using specialized long-handled instruments visualized on a video monitor.  In some cases, the operation may be started laparoscopically, but later converted to the traditional open method in which an incision is made in the front or side of the body under the ribs in order to complete the operation.  This can occur if, during the course of the laparoscopic procedure, the Surgeon finds an unexpected anatomic abnormality (scarring, fibrosis, too much fat, extra vessels, abnormal peripheral anatomy), complication (as outlined in previous paragraphs above), or finds that the operation is not progressing in the timeframe that it should (nonprogresssion), then a decision may be made to immediately change the operation to the corresponding open approach.  This decision is made in the context of your safety and that of the safety of the donor organ.

Other risks
During laparoscopic operations, the abdominal cavity  is filled with CO2 inert gas which allows the Surgeon room to work inside the abdomen.  If a significant vascular injury occurs such that insufflation gas enter the circulation in any significant volume, then this gas may travel to the heart causing a heart attack or to the brain, causing a stroke.  These risks are exceedingly low,  but not zero, and one should be aware of these risks before deciding on kidney donor surgery.

Postoperative Issues

Warning Signs: Wounds
If your incision develops increasing pain, shows discharge of whitish/greyish/greenish exudate, or shows redness creeping wider and wider around the incision, you should inform your physician for possibility of infection.

Generally speaking, you should continue to heal your wounds over the next 10-12 weeks and during this time, should try not to stress your incisions too much by performing activities which cause tension across the incision lines.  For example, for most abdominal incisions, it is recommended not to doing any straining or lifting of anything heavier than 10lbs for 6-8 weeks minimum.

Warning Signs: Activity
If during coughing/laughing/straining/lifting/activity you note a “snapping” sound or sensation in or around the incision, and notice the development of increased fluid coming out of the wound or more bulging than was previously appreciated, notify your physician for possibility of hernia formation or more acutely, wound dehiscence (strength layer under the skin opening up) or evisceration (strength layer has been compromised and bowel is coming out of the incision).

With regards to diet, if your bowels have not returned to normal when you go home, you should continue to eat small meals more frequently rather than several large meals and wait for your bowels to get more regular.  This typically takes anywhere from 5-10 days for most people.  In the meantime, continue to replace your fluids with water and electrolytes, treat nausea with fresh air, activity and medication as required (Gravol, Maxeran, Stemetil) and suppress pain with medication as required.

Warning Signs: Bowels
If your bowels continue to not work and you suffer ongoing abdominal bloating to the point of extreme pain or intractable nausea and vomitting you should notify your physician for possibility of postoperative ileus (slow gut) or obstruction.  As well, if you throw up fresh blood or have black, tarry stools, you should notify your physician for possibility of a gastrointestinal bleed.

For most procedures, a catheter will be placed temporarily via the urethra into the bladder for drainage of urine while you are recovering.  The catheter will be removed for a “trial of voiding” to make sure you can pass your urine before you go home.  If you are unable to do so, the catheter will be replaced and you will be asked to try again usually the next day.

Warning Signs: Urination
If you are unable to urinate for greater than 6 hours, although  you have the urge to do so and increasing lower abdominal pain with distension, you should notify your physician for possibility of urinary retention requiring re-catherterization.

Also if you notice more than cranberry colored urine passing via urethra, urinary frequency, urgency or burning, you should notify your physician for possibility of urinary tract infection.

Warning Signs: General
If you notice sudden onset shortness of breath, crushing/squeezing chest pain, or chest pain radiating to the neck or arm, massive headache, or difficulty talking or walking; seek medical attention immediately.

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