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Kidney Transplantation in the clinics of Germany

Around 15000 kidney transplantations are carried out every year in Germany. Modern equipment as well as postoperative observation achieves the best results.

The most important questions in the whole issue of kidney transplantation are:

1. the incompatibility of tissues
2. surgical technique

Many methods to eliminate the immunological incompatibility between the recipient's tissues and the transplanted kidney were proposed. The most reliable success has been achieved using antilymphocytic serum and chemotherapeutic agents. Positive results were obtained by use of 6-mercaptopurine, corticosteroids, and particularly imuran.

The left kidney is mainly transplanted to the right iliac region, extraperitoneal.

Technology of kidney transplantation

Two teams of surgeons carry out the operation in the donor and the recipient simultaneously. Ureteronephrectomy will be carried out in the donor. It should be carefully allocated the vascular pedicle and crossed as close to the major vessels. The ureter is distinguished over 15-20 cm. In this time, the recipient will be prepared for implantation of the kidney. For this purpose, the doctors allocate the hypogastric artery and cross it. Then they ligate its distal end and left its cephalic end for fistulization with the renal artery. The appropriate area of the bladder will be carefully distinguished for implantation of the ureter of the transplanted kidney.

After that the donor's vascular pedicle will be ligated and crossed. The kidney together with the ureter will be removed and immersed in cold saline solution. During 3-4 minutes the special team carries out the kidney perfusion through the renal artery by use of the solution containing polyglucin, heparin and novocaine at a temperature of 4°.

Then the implantation of the kidney has to be carried out. The team sets end-to-end arterial anastomosis between the renal and hypogastric artery. The renal vein is stitched with the outer iliac vein by the type of side-to-end anastomosis. Then the team makes decapsulation of kidney and implants the terminal of the ureter of the transplanted kidney into the bladder according to one of the following methods. Rubber tubes will be leaded to the field of vascular anastomosis and the bladder and the wound will be stitched.

The continuity of the urinary tract can be restored also by means of anastomosation of the ureters.

The maximal function of transplanted kidney is achieved in about 5-10 days after the operation.

We draw attention to the fact that kidney transplantation in Germany is possible only if a related donor is available!