Niertransplantatie II: Chirurgische Procedure

Preoperative management for kidney transplantation involves optimizing the recipient's metabolic state through diet, dialysis, and infection control.

Both the donor and recipient undergo comprehensive assessments, including blood typing, tissue typing, antibody screening for compatibility, and psychological evaluations.

Laparoscopic nephrectomy is usually performed on living donors to reduce blood loss, pain, and recovery time. Rarely an open nephrectomy with a lateral incision near the eleventh rib is performed.

In the recipient, the kidney is positioned extraperitoneally in the right and left iliac fossa for access, with the donor's renal artery and vein connected to the recipient's iliac vessels.

Once blood flow resumes, the kidney should turn pink and may produce urine immediately.

Postoperative transplant rejection includes hyperacute rejection within 24 hours, potentially requiring kidney removal, and acute rejection within 3–14 days, marked by elevated creatinine, fever, and tenderness, managed with immunosuppressants like tacrolimus.

H2-blockers or PPIs are used prophylactically to prevent corticosteroid-induced gastrointestinal complications.