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My
Final Step before Surgery- Plasmaphersis
The first
successful living kidney donor transplant was performed between
23-year-old identical twins in 1954. Since then thousands of
patients have received transplants without rejection primarily due
to the compatibility of the kidneys.
In order for me
to accept Rita’s incompatible kidney, the antibodies, which causes
rejection, had to be removed from my blood. This daylong process is
called plasmapheresis, a procedure that removes the plasma portion
of the blood where antibodies are located. I then received an
infusion of donor-type plasma serum to replace my antibodies to
prevent infection and the return of harmful antibodies.
The number of plasmapheresis is based upon the antibodies of the donor and
recipient. In my case, I required five treatments over a two-week
period beginning January 28th. In addition two
plasmaphersis were performed after my surgery.
Surgery
Day- Early Morning
On February 11,
2003 at 5:00AM, Rita and I arrived at Jefferson
Hospital. We were taken to a waiting area on the fifth floor
in order to
complete the necessary paperwork, prepare for surgery, and meet the vast number of
staff who would be participating in the two operations. Since this
was the first operation of its kind at Jefferson Hospital, the
number of surgeons, residents, nurses, technicians and observers
totaled more than twenty. Jefferson Hospital, being a teaching
medical school, videotaped both operations.
Since I needed
preparatory procedures in order to accept Rita’s incompatible
kidney, the surgeries for Rita and me began simultaneously in
adjacent operating rooms. We were rolled out of the waiting area
at the same time, giving each other a chance to share last minute prayers and smiles of
encouragement.
Rita’s
Surgery- Laparoscopic Nephrectomy
Prior to 1995 the
conventional nephrectomy required a large 10-15 inch incision.
In addition, the incision was made through muscle and usually
required the removal of a rib. The hospital stay, pain medication
and return to employment were more than double that of the modern
day laparocsopic surgery.
1995 was a
milestone in Organ Transplantation when my surgeon, Dr. Lloyd Ratner,
along with Dr. Louis Kavoussi, performed the world’s first
laparoscopic live-donor nephrectomy. This new technique allowed the
surgeon to remove the kidney through a hole slightly larger than a
silver dollar. Total recovery from conventional nephrectomy averaged
over five months while recovery time under the newer laparoscopic
procedure was just four weeks. By 2003, laparoscopic nephrectomy routinely was
being performed at Jefferson Hospital.
Rita’s surgery
began at 8:00AM under the supervision of Dr. Lise Kayler, Assistant
Professor of Surgery at the Jefferson Medical
College and one of the first women to join Jefferson’s transplant
faculty.
Under general
anesthesia, three tiny, buttonhole incisions were made in Rita’s
abdominal wall. A tiny camera called an endoscope along with other
instruments was inserted through these small holes. Once located,
Rita’s left kidney was removed through a small bikini-hole incision
and placed in a pan for immediate transport to my adjacent operating
room.
Rita’s surgery was completed at 11:30
AM.
My Transplant Surgery- First
Step- Laparoscopic Splenectomy
Dr. Ratner,
together with his team of transplant surgeons, began the operation
at 8:00 am by first removing my spleen. One of the main functions of the
spleen is to help create antibodies. These antibodies, recognizing
your new kidney as a foreign object, could attack and destroy the
organ. Compatible kidney transplants rarely require a splenectomy
since immune medication can normally suppress the antibodies and
reduce the chance of rejection.
Antibodies easily
recognize an incompatible organ and medication alone is insufficient
to prevent rejection. Therefore, in order to help control the
antibodies, my spleen was first removed before Rita’s kidney was
transplanted. A telescopic camera identified the location of the
spleen and removed the organ through a small abdominal incision.
The Final Step- Transplanting Rita’s
Kidney
I was now ready
to accept Rita’s kidney. A ten inch incision was made in the
lower left side of my abdomen. Rita’s kidney was then placed
below my left kidney. The blood vessels
of the transplanted kidney were then connected to my vessels. Blood
began to flow immediately into my new kidney. The ureter, which
carries the urine, was then connected to my bladder. Once all the
connections were made, the incision was closed.
An interesting
fact about kidney transplant surgery is that the existing kidneys
are rarely removed due to the added involved risks. Those
kidneys remain connected to the blood system, even though they are
not functioning. I, therefore, have three kidneys in my
abdomen.
Due to the
complexity of the operation, the kidney transplantation was
completed in seven hours.
Post Operation
After surgery I
was transferred to the intermediate surgical intensive care unit (ISICU)
where I was connected to intravenous tubes and a heart monitor. My
blood and urine were frequently tested. In addition, I was given
large doses of immunosuppressive medications to treat and prevent
rejection of my transplanted kidney. 
In all major
surgery, complications can occur. Kidney recipients may experience
infection, adverse reaction to medication, and organ rejection, to
name a few.
While I
experienced some complications, Rita’s kidney started functioning
immediately with no signs of rejection. I was transferred to
the renal transplant floor where nurses and doctors continued to
monitor my blood and urine.
Up until my kidney experience began in 1987 I was in good health.
I did not realize the impact that prolonged incapacitation could
have on even the simplest function. I did not appreciate
the significance of exercising your arms, legs, and body immediately
after surgery. As a result of being bedridden so long, blood clots
starting forming in my legs. It also became difficult to walk and
breathe. Heparin, a blood thinning medication, was administered to
prevent further blood clots. My breathing problems were partially
caused by lack of exercise and fluid near my lungs. A catheter was
implanted to reduce the fluid and I was transferred to Jefferson
Hospital's rehabilitation unit. |
