I just graduated nursing school a couple of weeks ago, and in the frenzy of completing all assignments and studying my ass off, I failed to clarify something that has me scratching my head. When kidneys are transplanted, the old diseased kidneys are usually left in place; the arteries and veins feeding and draining the kidneys of blood are usually just tied off. The new kidney is placed much lower, down in the pelvis.
Why is this? More to the point, tying off the renal arteries and renal veins would completely destroy the kidneys, no? And the necrotic tissue would just sit there, begging to be the impetus for a bacterial infection, wouldn’t it?
Set a budding RN straight. Me passing the NCLEX is dependent on this very question.
They’re not. The native kidneys are nowhere near the site of the allograft, as you mentioned. They are much harder to get to, and require the patient to be in an entirely different position, with a different incision (unless done laparoscopically, but AFAIK transplants are always implanted via an open incision). Speaking as both a kidney transplant recipient and a physician who has provided care to kidney transplant patients in the operating room, I have to respectfully disagree with Messrs Brunner & Suddarth.
There are occasionally indications for nephrectomy of one or both native kidneys during, before, or after a transplant. But in general, they are left alone.
So it’s riskier to remove diseased/useless kidneys than to just leave them there? Don’t you have to disconnect the inputs and outputs from old kidneys and reattach them to the new ones?
You need a reason to take them out, not to leave them in. The status quo is to leave them where they are because taking them out is a big unnecessary surgery.
Yes. Generally it’s entirely harmless to leave them in place.
No. As Malienation mentioned in the OP, they are placed in different locations. See this imagefor details. The donor kidney is resected along with the renal artery and vein, and the ureter. The renal artery and vein are attached to the iliac artery and vein in the pelvis, and the ureter is attached to the bladder. Placing the kidney in the pelvis also makes it much easier to attach the ureter to the bladder and avoid ureteral complications.
The text book mentioned does say that the renal artery and vein are being used for the transplant kidney. If that is the case, their old attachments to the kidney MUST be tied off,right ?
I think the text book is going over this topic very quickly and doesn’t deal with the doctors decisions. The text book mentions tying off, so that the nurse might remind the doctor to tie off the stubs at the kidney side of the cut if the kidney is being left there.