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Dr. Shaw is proud to be one of two urologists in Central Texas to participate in the Renal Transplant Program at North Austin Medical Center.
Dr. Shaw received training at the Tulane Medical Center in New Orleans, one of the largest of such programs in the Gulf Coast Region. Since 2004, he has been performing this kidney transplant surgery at St. David’s North Austin Medical Center.
Kidney transplantation is one of the most common and successful organ transplant procedures performed today. Thanks to decades of fine-tuning, renal transplantation has become a life-saving alternative for thousands of patients with end-stage renal disease.
The kidneys are fist-sized organs responsible for the fluid and chemical balances of your body. Located on both sides of the spine behind the liver, stomach, pancreas and intestines, these two organs are protected by the lower ribs and muscles of the back and sides.When healthy, your kidneys cleanse the blood of waste products and produce urine. They also balance essential elements, such as sodium and potassium, while providing hormones necessary to regulate blood pressure and red blood cell production.
When these organs fail, harmful wastes build up in your body, leading to high blood pressure, increased fluid retention, imbalances in salts and acids in the blood, and decreased red blood cell production. All of those events can have harmful, possibly life-threatening effects on your heart and brain.
Each year about 90,000 Americans develop end-stage renal disease. The most prevalent causes of chronic kidney failure include diabetes, high blood pressure and glomerulonephritis, an inflammation of the organ’s filtering units. These conditions account for three-quarters of reported end-stage cases.
There are many symptoms associated with kidney failure. You may experience swelling in your hands, feet and face along with headaches due to high blood pressure, and even seizures. Your complexion may pale due to anemia, and your urine may become coffee-colored. You may also have chronic bad breath that cannot be freshened by brushing your teeth. You may have fatigue and itchy skin.
The most common treatment for end-stage kidney disease is dialysis. This is the process of removing waste, excess water and chemicals (e.g., potassium, sodium, calcium and acid) from the body. There are two types of dialysis: hemodialysis and peritoneal dialysis.In hemodialysis, the patient’s blood stream is connected to an artificial kidney machine outside the body. Hemodialysis treatments are usually done three times per week and take anywhere from two to six hours for each session. Many patients with kidney failure undergo peritoneal dialysis, a similar cleansing process conducted through a tube in the abdomen.
While hemodialysis and peritoneal dialysis will not cure kidney failure, they can replace the work of your kidneys, helping you feel better and live longer.
About 30 percent of kidney failure sufferers are suitable candidates for a kidney transplant, a surgical procedure to restore function by replacing two failed kidneys with one healthy organ.
About half of kidney transplants come from non-living (or deceased) donors, even though family members, spouses (living, related donors) and friends (living, unrelated donors) can safely donate if tests can prove they’ll have nearly normal kidney function after giving up one kidney.
A kidney transplant is usually placed in the lower abdomen without any need to remove the failed kidneys. The new kidney’s artery is connected to one of the patient’s pelvic arteries. The kidney’s vein is connected to one of the veins in the patient’s pelvis. The ureter, the tube that drains urine from the kidney, is connected to the bladder or to one of the patient’s own ureters. In children, the blood vessels from a large adult kidney transplant are frequently connected to the child’s aorta and inferior vena cava.
If you are the donor, you can expect to leave the hospital usually 2 days after the kidney transplant surgery. With a traditional (open) operation, there is usually a single incision about eight inches in length. Dr. Shaw specializes in hand-assisted laparoscopic surgery, a minimally invasive procedure, in which you will have four smaller incisions each about the width of your thumb, and the largest of which will be about four inches long, much of which is hidden around the navel. About 90 percent of transplanted kidneys are functioning at the end of one year. Between 3 percent to 5 percent of these kidneys stop working each year after that. The kidney is always at risk for rejection, so it is very important for kidney transplant patients to take all of their medicines as directed to prevent this problem. Overall, a kidney from a living donor has a better survival rate than a kidney from a non-living donor.
Any number of risk factors can contribute to kidney failure including high blood pressure, hardening of the arteries and diabetes. It can be brought on by untreated strep infections, recurrent and chronic kidney infections, systemic lupus erythematosus, severe forms of diarrhea, kidney stones or even chronic use of non-steroidal anti-inflammatory drugs.
No. Blood types do not have to be identical, just compatible. Markers or “antigens” on the surfaces of your red blood cells determine your type. ABO blood group incompatibility between the donor and recipient can provoke an immediate rejection. This means that a donor with “O” blood type can donate a kidney to a patient who has “O,” “A,” “B” or “AB” blood type and that transplant candidates with “A” or “B” blood types are usually limited to kidney transplants from donors with the same blood type or “O” blood type.
Antibodies, proteins manufactured by the immune system that react specifically to donor tissue. A “negative cross-match” or lack of reaction when blood samples from a donor and recipient are test tube mixed confirms when a kidney is acceptable.
The waiting period for a deceased donor kidney varies from patient to patient, depending most on patient blood group and degree of antibodies in the blood. Since there are not enough deceased donor organs for every person who needs a transplant, potential recipients are placed on a national list, administered by the United Network for Organ Sharing (UNOS), a private nonprofit organization contracted by the federal government. Each time an organ becomes available, a recipient is chosen based on a point system reflecting blood type, waiting time, tissue match and antibody levels. Although some people receive their organ within several months, the median delay is two to three years. In contrast, a living-donor transplant can be scheduled immediately, thus making it an optimal choice.
Since this procedure is carefully coordinated between Dr. Shaw’s office and the North Austin Medical Center Transplant Department, please feel free to call us with any questions about getting ready for your procedure. The day before your procedure, we ask that you take only a clear liquid diet (soups, broths, etc). However, do not eat or drink anything after 12:00 midnight the night before surgery. Wear comfortable, loose-fitting clothing like a jogging suit on the day of your procedure. Bring a list of all the prescription and nonprescription medications that you take regularly with you on the day of the procedure.
Please plan to arrive two hours prior to your treatment.
The procedure usually takes three hours, and Dr. Shaw will come and speak to your family afterwards
Upon waking from the procedure, you will have a catheter draining your bladder. I have yet to meet a person who likes having a catheter, but relax, the catheter is typically removed first thing in the morning.
It is not unusual to have a sensation of wanting to urinate, or to have bladder spasms after surgery. This usually goes away within 1-2 days.
Minimal Incisions! That’s the good part. Laparoscopic Donor Nephrectomy is performed with two tiny incisions, no wider than your thumb. The largest incision, about four inches in length, is just above and below the navel. Because of this, about half the incision is usually hidden in the navel area.
After the procedure, most patients will feel sore around the middle of the abdomen and on their left side where the surgery is usually performed internally. A foley catheter draining the bladder is usually removed the morning after surgery.
We utilize a Patient Controlled Anesthetic (PCA) which gives pain medication on a regular basis, as well as via an on-demand button that the patient can use for additional pain control as needed.
After the PCA is removed, a combination of oral and IV pain medication is used.
The day after surgery, we encourage early ambulation or movement around the room and hallways with the assistance of nursing staff.
We gradually advance your diet as tolerated.
Advice After Laparoscopic Donor Nephrectomy –
Definitely rest up for a week after the procedure. Drink at least 6-8 glasses of water a day, and stay well hydrated.
For pain, Tylenol works great for mild discomfort. For pain not relieved by these medications, use the prescription Vicodin that was prescribed for you. Do not use ibuprofen, Motrin, or other NSAIDS, as this can affect the function of your remaining kidney.
Do not strain when having a bowel movement. Expect irregular bowel habits until fully recovered. Increase fiber in your diet with fruits, salads, etc. You may need a stool softener or laxative such as Metamucil. Do not take blood thinners or aspirin products for one week or as directed by your physician.
Take it easy for the first week after the procedure. Do not drive or operate dangerous equipment for one week. You may be able to resume non-strenuous activities after one week unless otherwise directed by your physician. Avoid strenuous exercise, heavy lifting greater than twenty pounds, bike riding, and yard work for two weeks. After two weeks, you can gradually increase your work load until 4-6 weeks, at which you can usually resume most activity. The main issue is to reduce chance of a hernia at your incision site, so please use your common sense! If doing some activity is uncomfortable or hurts, don’t do it!
Stay well hydrated, drinking 6-8 glasses of fluid a day. Eat healthy with lots of fruit, vegetables, and salads.
You may experience bruising or swelling around the incision sites, especially around the navel area. This is normal and should subside in one to two to four weeks. After a few months all the inflammation and swelling will go away, and the incisions will slowly resemble a thin line and barely be visible.
Usually, Dr. Shaw or his staff will communicate to you a desired follow-up time frame, usually 4-6 weeks postoperatively. Please call us the day after discharge to verify a time to see us in the office.
Recent studies suggest that healthy kidney donors will live at least as long, if not longer than their similar age and health-matched counterparts. The transplant department is deliberately exhaustive in their workup of potential kidney donors for this reason. Most patients should be able to get back to normal activity levels with minimal restrictions 6 weeks after the procedure. The North Austin Medical Center Transplant Department will coordinate long term monitoring of your remaining kidney with your primary care physician.