SURGERY AND POSTOPERATIVE CARE
The kidney is transplanted into the abdomen. The native kidneys are not removed so the cat Usually ends up with 3 kidneys. Occasionally, one or both native kidneys may be removed to try to prevent problems related to these kidneys
The surgery is a complex challenging procedure that is usually done in a chronically-ill patient. Thus, there are many possible acute complications which can occur either during or after surgery. These may include anesthetic problems, delayed function or primary nonfunction of the implanted kidney, arterial or venous thrombosis (clots), leakage of urine at the ureteral implant site, shock, heart failure, paralysis, fatal infection, seizures, pulmonary embolism and death.
The blood vessels of the transplanted kidney are attached to the aorta and vena cava in the abdomen behind the position of the native kidneys. To gain some perspective on this procedure, the suture that is used is finer than a human hair. To see a portion of the surgery, click on the movie link here (QuickTime, 900K). The ureter is attached to the bladder so that urine will drain into its proper place.
In the relatively low-risk patient with minimal weight loss or debilitation, the survival rate would be expected to be about 90% or better (see UW-SVM Specific Information for more details). Survival rates will decrease as the patient becomes more debilitated. A successful feline transplant program would be expected to have an overall 70-85% "survival to discharge from the hospital" rate.
Longer term complications primarily involve acute graft rejection and the potential for infections. As mentioned above, chronic graft rejection may result in recurrence of renal failure in some cats after several years. Rejection is monitored by weekly examinations for the first month after transplantation. Maintenance of a good appetite and low serum creatinines are assessed along with urine specific gravity when urine can be obtained by free catch, red cell counts (PCV), and cyclosporine A blood levels. After the first 4 weeks the interval between exams may be gradually extended to one month or more.
Rejection of the transplanted kidney is most common in the first month and will be accompanied by malaise, vomiting, and depression and is confirmed by laboratory blood testing. Rejection must be recognized and treated immediately to prevent destruction of the transplanted kidney. Treatment of rejection requires immediate hospitalization with fluid therapy and intravenous cyclosporine A and steroid therapy. When the rejection episode is controlled, oral cyclosporine A treatment is reinstated at a higher dose level.
Although the risk of rejection is highest in the first month, it must be remembered that rejection is a life-long risk. Thus, the owner should observe the recipient with this in mind and if there is any question that rejection may be occurring, the recipient should be tested immediately to rule out such a possibility. As the owners of these patients become acquainted with how their cats are doing after surgery, it becomes obvious to them when things are not going well and the cat needs to be examined and have blood testing done.
Postoperative monitoring and care of the transplant patient is most intense, in terms of blood testing and monitoring, the first few months after surgery. Gradually, the intervals between blood tests will get longer until testing is done every 1-3 months.