RENAL TRANSPLANTATION

Abstract

The surgical techniques required in homotransplantation involve more than the homografting procedure since recipient bilateral nephrectomy and splenectomy are integral parts of the plan of treatment as practiced at the University of Colorado Medical Center. Originally it was thought that multiple operations would be required because of the critical condition of patients with terminal uremia. Experience has shown that this is not the case, and for various reasons bilateral nephrectomy, splenectomy, and homotransplantation are better tolerated when performed as a single all-inclusive operation. The technical problems are the same as those encountered in any major surgical operation except that there is very little margin of safety because of the predictably poor healing capacity of these metabolically depleted patients and the necessity for immunosuppressive therapy. Special care is required to avoid breaches in aseptic technique. Preoperatively, the patient's own bacterial flora is studied by obtaining cultures of all body orifices and skin. At time of surgery, all operative sites receive double skin preparation and are heavily draped. One of the potential sources of wound contamination is the bladder, which must be opened for ureteral implantation. This hazard is minimized by performing a separate 10-minute perineal prep, placing a Foley catheter, and instilling a solution containing bacitracin and neomycin into the bladder. The fluid is retained until just before ureteral implantation is begun. A variety of surgical approaches may be employed depending upon the circumstances of the individual case. Most versatile and most com-