Renal Transplant and the ICU

*I have some photos of both pre and post transplant. I will post these in a separate blog after I discuss the hospitalization post-transplant.)


Once in the OR and on the surgical table I told the anesthesiologist where to place any IV lines on my L arm, or to hit a vein in my neck. Apparently he didn't believe me about the placements because, after putting me out completely, he spent an hour and a half trying various locations on the arm, finally placing the line in my very deep  AC (antecubital) artery. As a result of his "fishing around" for a vein, I had some nasty bruising on the arm.
In total, I had the Arterial line, which was used to monitor blood pressure, and two lines in my neck in the R side, one into the Internal jugular, and one into the External Jugular. These two lines were always planned, so they were no surprise.
Also in this time frame, a Foley catheter was put in place so that any urine would automatically drain, and my bladder would not have to work much, giving it time to expand at a natural pace. 

From what I have been told, the surgery went better than expected. The R slanted incision was made on my L side from just above the pelvic girdle down to the middle of my bladder's location. Usually, a renal transplant is placed on the R side of the patient. Why this change was made is unclear to me. It is possible that the scarring (from previous surgeries) on my R abdomen was too much for a clean incision; or, that the kidney, which was larger than average, was too big for the R side.
In any event, the surgeons made an approximately 12-14 incision--larger than I was expecting, by the way. This kidney has two Renal Arteries, which is a bit uncommon, but not unheard of. The arteries were attached to my blood system, with one artery being so small that the surgeon used the smallest surgical silk they had. IF that artery had failed, I would have lost about 10% perfusion to the organ. However, the very skilled surgeon was able to successfully attach both arteries, so I have 100% renal perfusion.
Also, the surgeon used surgical glue to adhese the incision closed, and added surgical tape over the surface skin along the length of the incision. Between the two, the scar should end up being clean and minimal in appearance.

Also, the decedent's ureter--the tube from the kidney to the bladder--which comes with the kidney was also successfully attached to my bladder. A stent is used at the connection with the bladder to allow the ureter and stitching to heal properly without distending the ureter and causing any tears at the connection. The stent will be removed on 12 June.

Now, because my bladder had not been used for three and a half years, and being like a muscle, had shrunk to the size of a kidney bean...very, very tiny. Once everything was hooked up, the new kidney began producing urine immediately, which is an excellent outcome so soon after transplantation. Some kidney's take time to "wake up," to use the proper vernacular. In that case, transplant patients must continue doing dialysis until the organ kicks in, if ever...which sometimes happens.

From what I was told the surgeons found nothing unexpected, and the entire surgery went quite well. Total surgery time was about four hours, with 1.5 hours used to place all the IV line access (as described above), then 2.5 hours on the surgical table, followed by about one more hour in recovery during which I was NOT awake or lucid at all. The surgical team notified my wife every hour on the progress and how I was doing. About thirty minutes after the surgery was completed the surgeon came out and talked to her, telling her how the surgery went, and asked for any questions.

After being in Recovery, I was taken to a room in the ICU (Intensive Care Unit) because of my new cardiac issues. This was a purely precautionary move by the doctors so I could be closely monitored in the event any serious cardiac events arose. Luckily, none did.

I was completely asleep in the ICU for about forty minutes before I began to be aware of the pain I was in; which was far worse that I was expecting. That's because I was under the assumption that the surgeons would be using the same site through which my older, cyst engorged kidney's had been removed, which is about three inches in length. The realization that the pain was far more intense than I thought it would be was hard to endure. Add to that was the fact that the ICU had not yet received the necessary pain meds, and I was in terrible pain. Once the meds had arrived--about an hour after my arrival--it took around two hours for the pain to be under some sort of semi control.  In the meantime, I was having muscle spasms along the incision, causing horribly intense pain; so much so that apparently, I was crying and shaking badly, crying out every minute or so.
My wife and our friend Kelly took turns holding my hand, stroking my hair gently, and verbally trying to keep me calm. Both had to leave occasionally to get a break from my seeming constant cries of pain.
During this time I also became very aware of how dry my mouth was. I'm talking your tongue sticking to the bottom and roof of your mouth dry. This added to my incredible discomfort. The nurses offered ice chips in moderation, or regular swabbing of my mouth with water. I actually used both, which helped immensely.
The night following surgery was very long! Finally, at around 300a, I was able to sleep again following numerous injections of pain meds via the on-demand pump at my disposal. Even sleeping fitfully was better than not sleeping at all.

The next morning the nurses had me up and walking...however briefly. Plus, having had abdominal surgery, I was expected to do the breathing exercises to ward off potential pneumonia. I started in on these exercises after my first walk.  Once I was done with that first walk I asked to be seated in the reclining chair that was in my room--I just had to get off of my back after being in the prone position for over twelve hours. Plus, the beds in this hospital are anything but comfortable--a purposeful tactic to get patients to go home, I believe.
Anyhow, I spent most of that day in the chair, doing the breathing exercises regularly and even falling asleep a number of times. Helping me to be comfortable in this position was the abdominal binder that was placed around me once the transplant surgery was completed. This binder is a huge support to any abdominal surgery patient as it constricts the overall movement of the abdomen. This also aids in the overall heal process as the body has lessened pain to deal with. Don't get me wrong...I was in plenty of pain. However, the binder simply aids in the patient being a bit more comfortable; until they move or walk, that is! :o)  I would wear the binder constantly while in the hospital, then during the first two weeks at home. Now I only wear it when traveling anywhere. At six weeks post-surgery I can go without the binder entirely--which is next week, by the way!

As I stated earlier, I began producing urine immediately once the kidney was hooked up. Post surgery I was producing urine in volume. In fact, I lost nearly 3 Kg in water weight during my time in ICU!


Another vital aspect of healing from abdominal surgery is the ability of the body to produce and pass gas. This actually indicates that the digestive tract was not impacted during the transplant--or that it is healing properly following any surgery that involves the intestines. My first day post-transplant I was passing gas, though painfully as the body really doesn't like anything cutting into it. The pain receptors were firing constantly, and even the simple passing of flatulence caused lots of pain.

I spent two days in the ICU, and the precautions observed because of my heart were for naught as my vitals were excellent, stable and showed zero signs of cardiac compromise.
In fact, I did far better post-transplant than anyone expected! Having had numerous abdominal surgeries before, I knew what to expect, how to recover best and how to push through the pain to get up and walking as often as I could tolerate.

So, on Saturday evening--two and a half days after surgery, I did so well that the doctors ordered that I be moved to a regular transplant patient room on the 10th floor.

(Up next: Finishing My Hospital Stay and the Plethora of Meds I Need)

Good Health to All!

ScottW