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Removal of transplanted renal allograft
CPT4 code
Name of the Procedure:
Removal of transplanted renal allograft (Nephrectomy of transplanted kidney)
Summary
The removal of a transplanted kidney involves surgically taking out a donor kidney that was previously transplanted into a patient. This procedure might be necessary due to various complications or failure of the transplanted organ.
Purpose
- Addresses significant dysfunction or failure of the transplanted kidney.
- Relief from symptoms such as pain, infection, and systemic effects due to a failing transplant.
- Prevention of further complications from a non-functioning or problematic kidney.
Indications
- Chronic rejection of the transplanted kidney.
- Infection or sepsis originating from the transplant.
- Severe pain or clotting issues associated with the transplant.
- Formation of masses, tumors, or other abnormalities in the transplanted kidney.
- Acute rejection unmanageable with medications.
Preparation
- Patients are generally advised to fast for several hours before the surgery.
- Blood tests, imaging studies (CT scan, Ultrasound), and urine tests might be performed to assess the current function and condition of the transplanted kidney and surrounding tissues.
- Medication review and adjustments may be necessary, particularly involving immunosuppressants and anticoagulants.
Procedure Description
- The patient will be placed under general anesthesia.
- A surgical incision is made in the abdomen, usually near the site of the transplanted kidney.
- The surgeon will carefully detach the kidney from the associated blood vessels and ureter.
- The transplanted kidney is then removed.
- The incision is closed with sutures or staples, and a drain may be placed to remove any excess fluids.
- Tools used may include scalpels, forceps, clamps, and possibly laparoscopic instruments.
Duration
The procedure typically takes about 2 to 4 hours, depending on complexity and any present complications.
Setting
This procedure is performed in a hospital operating room.
Personnel
- Surgeons specialized in nephrology and transplant surgery.
- Anesthesiologists to manage anesthesia.
- Surgical nurses and technicians assisting with the operation.
- Post-operative care team, including nurses and possibly a nephrologist for follow-up.
Risks and Complications
- Common risks: Bleeding, infection, pain at the surgical site.
- Rare risks: Damage to surrounding organs, severe blood loss, deep vein thrombosis (DVT), complications from anesthesia.
- Possible complications: Acute kidney injury, urinary problems, recurrence of original symptoms if underlying cause persists.
Benefits
- Removal of a dysfunctional or harmful kidney reduces infection risk and associated symptoms.
- Relief from pain and other local complications.
- Improved overall health by removing the source of systemic issues.
Recovery
- Hospital stay of a few days, depending on patient condition and surgical complexity.
- Post-operative care includes pain management, monitoring for infection, and ensuring proper fluid and electrolyte balance.
- Patients should avoid strenuous activities for 4-6 weeks and follow a specific diet and medication regimen.
- Regular follow-up appointments to monitor recovery and kidney function.
Alternatives
- Non-surgical management might include stronger immunosuppressive therapy, though this is not always effective.
- Dialysis as a method to manage kidney failure without removing the transplant.
- Retention of the transplanted kidney in cases where risks of removal outweigh potential benefits, monitored carefully for complications.
Patient Experience
- Intraoperative experience is pain-free due to general anesthesia.
- Post-procedure, patients may experience pain at incision sites managed with prescribed painkillers.
- Patient feels progressively better as early recovery phase advances, with follow-up care helping adjust medications and manage any potential discomfort.