Kidney Extraction from Living Donor

Kidney extraction for living donors is applicable to: 1. Age is generally considered to be most suitable between 20 and 50 years old. Children should not be given kidneys unless the donor has hydrocephalus or twins; it is not suitable for older ages, because the elderly often have occult lesions, such as hardening of the arteries, chronic inflammation, etc., and their renal compensatory dysfunction, tolerance Nephrectomy is poor. 2, living relatives of the relatives of the living donor (identical donor): the same donor, the same type of transplant, no immune response problems, long-term survival, the effect is ideal. Sibling donor: must choose according to HLA matching results, Terasaki divides it into 5 levels: 1 The kidney donor and the recipient are completely matched to the A grade; 2 The recipient 1 antigen is The donor has no grade B; 3 donor 1 antigen is the recipient's C grade; 4 donor 2 or more antigens are the recipient's D grade; 5 recipient serum and donor lymphocyte cross fit When it is positive, it is grade E. The above-mentioned A-level complexes are all identical, and the effect of transplantation between identical twins can be obtained after transplantation; the B-class is semi-identical, and the siblings are better than the parent donors. The results of the other levels of matching are correspondingly reduced. Unrelated living donors: According to HLA matching, there are few ideal opportunities, and the transplant effect is the same as that of cadaver donors. Treating diseases: uremia Indication Kidney extraction for living donors is applicable to: 1. Age is generally considered to be most suitable between 20 and 50 years old. Children should not be given kidneys unless the donor has hydrocephalus or twins; it is not suitable for older ages, because the elderly often have occult lesions, such as hardening of the arteries, chronic inflammation, etc., and their renal compensatory dysfunction, tolerance Nephrectomy is poor. 2, living relatives of the relatives of the living donor (identical donor): the same donor, the same type of transplant, no immune response problems, long-term survival, the effect is ideal. Sibling donor: must choose according to HLA matching results, Terasaki divides it into 5 levels: 1 The kidney donor and the recipient are completely matched to the A grade; 2 The recipient 1 antigen is The donor has no grade B; 3 donor 1 antigen is the recipient's C grade; 4 donor 2 or more antigens are the recipient's D grade; 5 recipient serum and donor lymphocyte cross fit When it is positive, it is grade E. The above-mentioned A-level complexes are all identical, and the effect of transplantation between identical twins can be obtained after transplantation; the B-class is semi-identical, and the siblings are better than the parent donors. The results of the other levels of matching are correspondingly reduced. Unrelated living donors: According to HLA matching, there are few ideal opportunities, and the transplant effect is the same as that of cadaver donors. Preoperative preparation 1. Asking about the medical history and comprehensive physical examination of the donor must be healthy, but also to understand their ideological understanding, psychological state and mental stability. 2, laboratory tests include 1 blood, urine routine, platelet count; 2 detection of blood coagulation mechanism; 3 liver, kidney function, electrolyte, blood glucose determination; 4 blood, urine, sputum, throat swab to send bacteria, mold culture; 5 Hepatitis immune serum; immune complement; anti-basement membrane antibody assay. 3, immunological examination including 1ABO blood group; 2 lymphocyte poisoning cross-matching test; 3 mixed lymphocyte culture; 4HLA matching; 5PRA (panel reaction antibody detection). 4, other examinations include: 1 chest, abdominal X-ray film; 2 nuclear kidney map; 3 ECG; 4 drainage urography; 5 renal angiography. Surgical procedure The living donor kidney is generally selected on the left side because the left renal pedicle is easy to be exposed and the left renal vein is long, which is convenient for kidney transplantation operation. 1, under the 12th costal incision through the oblique oblique incision (through the 11th intercostal incision, pay attention to protect the pleura), cut according to the layer, carefully stop bleeding, reach the kidney fat sac. 200 ml of 0.25% procaine (containing 800,000 U of penicillin and 1.0 g of streptomycin) was injected into the renal fat sac to make it diffuse and infiltrated. Its purpose is to facilitate peri-kidney separation; procaine infiltrates the renal pedicle to prevent renal artery spasm; containing antibiotics can prevent wound infection. 2, kidney pedicle treatment cut the kidney fat sac, separation of the kidney, to avoid damage to the renal capsule. The renal artery was infiltrated again with a 1% lidocaine solution, and the adrenal, spermatic (or ovarian) veins were ligated separately. Keep the renal hilar fat and ensure blood supply to the ureter. The ureter is cut off at the plane of the iliac crest, the distal end is ligated, the ureteral mesentery is preserved, the blood supply is ensured, and the renal door is separated upward. 3, with 20% mannitol 250ml, furosemide (furosemide) 40mg, intravenous drip. In the case of diuresis, the kidneys and veins were clamped and cut at the beginning, and the donor kidney was immediately removed. Then the renal artery and vein were double-ligated, and the renal artery stump was sutured through suture. 4. The extracted donor kidney was immediately immersed in a kidney preservation solution at 2 to 4 ° C, intubated through the renal artery, and lavage was started immediately. Renal artery <1mm can be ligated, otherwise it should be anastomosed with the main branch of the renal artery to ensure the quality of the donor kidney. 5, close the incision Before closing the incision, the wound cavity should be checked again to confirm that there is no active bleeding, the drainage is placed in the renal fossa, and the skin is additionally punctiated, and then the incision is closed according to the layer. The operation of the right kidney is the same as that of the left kidney. Special attention should be paid to the treatment of the right renal vein. If a vena cava is taken, the vena cava incision should be carefully sutured.