WHAT HAPPENS IN THE HOSPITAL: You have chosen the option of receiving a kidney transplant as a treatment for End-Stage Renal Disease. When a kidney, which seems suited for you becomes available, the call from the Carolina Organ Procurement Association will be received by your transplant coordinator at ECU Transplant Division. You will receive a call to home to come to the hospital. WHEN YOU ARE CALLED: You need to come to the hospital immediately, but drive carefully!! The transplant coordinator may tell you that you are number 1 or 2 or 3 on the list for the kidney. Even if you are not number one you must respond in order to be prepared. You could suddenly move up on the priority list. Sometimes the person who is ahead of you can not be contacted, or can not be transplanted at this time due to illness or infection, or the final crossmatch shows a strong incompatibility. You just might be the right person in the right place at the right time. Tell the coordinator of you are not presently well, have any sort of infection, or are currently on antibiotics. Do not eat or drink anything from the time you are called. Bring all of your medications with you. Bring your home dialysis records with you. If you are diabetic, bring your blood sugar monitoring equipment and records with you. WHEN YOU ARRIVE AT THE HOSPITAL: You will be examined and asked questions about your recent health. You will be asked to sign four permits. One permit is for the surgery to transplant the kidney. The second permit is for the placement of a central catheter in a blood vessel under you collarbone to monitor the pressure of blood at the level of your heart, the third permit for hemdialysis, if needed and the fourth permit is required by the hospital. You will have chest X-rays to check for fluid or infection in you lungs. An EKG will be done to test for heart function. A urine sample is taken to check for bacteria. If you are unable to void urine, you will need to have a catheter placed in your bladder to wash the bladder with sterile saline, collect a specimen for bacteria, and install a small amount of antibacterial solution into the bladder to reduce the risk of a bladder infection after surgery. Blood samples will be drawn to check your BUN, Creatinine, Potassium, and to check for signs of infection. Extra blood will be drawn for crossmatching your blood against the kidney donor's blood. If you have not dialyzed recently, you may need a dialysis treatment before surgery. You may be given enemas to clean your bowels. Either the left or right side of your abdomen will be shaved from your waist to your thighs. A special pre-surgical shower with antibacterial soap will be done. The final crossmatching of your blood with blood from the kidney donor will be done while you are being prepared for surgery. If problems are detected which indicate that your blood clashes with the blood of the donor, you can not receive this kidney and the surgery will be cancelled for you. You will receive anti-rejection medications in the operating room. This will help to prepare your body for it's new kidney. You will go to the operating room on a stretcher. You will be given anesthesia in your IV line and you will quickly fall asleep. About three (3) hours later you will awaken in the recovery room. IN THE RECOVERY ROOM: You will awake up in the recovery room with several new pieces of equipment that you did not have when you went in. Each of these devices is absolutely necessary to monitor your recovery and to monitor your new kidney's function. It is expected that you will be uncomfortable and perhaps feel cold and anxious. Just tell the nurses how you feel and they will administer pain medications, put extra warm blankets on you, and generally do whatever they can to make you feel as comfortable as possible. You may have oxygen on your face when you first wake up. A sterile dressing will cover the site on your abdomen where your new kidney has been placed. Your surgical incision will be closed with staples. The staples will remain in to 14 days and will be removed in Transplant Clinic. You will have an IV line in a vein in your arm for administering fluids and medications. You will still have that central pressure monitoring line, which was placed under your collarbone surgery. A foley catheter will be in your bladder. Some kidneys begin to produce urine while the patient is still in the operating room. Some do not begin to make urine until several days later. It varies. Large amounts of fluids are given intravenously in the first hours after the surgery to stimulate the kidney and to flush the kidney. Fluid intake and urine outputs are measured very closely to maintain a balance. Because even slight variations in the volume of fluid "in" compared to the fluid "out" can shift this balance you will notice that the urine is measured with a very precise measuring meter. It is not unusual to have some blood and clots in the urine for a while after the surgery. Because the anaesthesia causes the stomach and bowels to relax and slow down their normal functions, you might awaken with nasogastric(N/G) tube in place through your nose and throat to your stomach. It is important to have this tube in the stomach until the digestive system resume its regular rhythm. Otherwise, you might have nausea and vomiting, so this is to protect you. The nurse or physician will listen frequently to your abdomen with a stethoscope to hear gurgling sounds in the stomach and the bowels. When you start having normal bowel sounds and can pass gas this tube will be removed. You will be observed in the recovery room until you are fully awake from the anaesthesia. Then you will be transferred to the Surgical Intermediate Unit in the hospital where the staff have the expert skills an experience to provide you with the attention and monitoring you and your new kidney will need for the next several days. WHEN YOU ARRIVE IN YOUR ROOM AFTER SURGERY: One of the first things you may notice is that the people taking care of you are very particular to protect you from any germs. They will wash their hands repeatedly, wear gloves to touch any tubes or dressings, and sometimes wear masks. All of these special precautions are taken to prevent you from getting infections. Because your immune system will be suppressed to prohibit the rejection of the graft kidney, you will be much more susceptibly to germs. You will be much less able to fight off and recover from an infection. Extra care is needed. You will receive one-to-one nursing care for the first twenty-four (24) to thirty-six (36) hours as both you and your new kidney get used to each other. The nurse will closely record the precise amount of fluid you receive as well as the urine (or other fluids) you put out every hour for the first day and then every two (2) hours for the next couple of days. As soon as you are able, you will be asked to keep your own intake and output records so this is a good time to begin to listen and learn how these fluids are measured and recorded. You will probably keep the bladder catheter foley for five (5) to seven (7) days. Remember, there may be blood or clots in the urine for several days. If it had been a long time since you made normal amounts of urine, some cramping spasms of the bladder muscles should be expected as the bladder gets used to holding some urine volume again. Sometimes, irrigating the catheter with sterile saline is necessary to clear clots out of the catheter, which can block the outflow of urine. Some bladder cramps may be inevitable and uncomfortable. A suppository may be inserted in the rectum at intervals to relieve the bladder of spasms. Do not be surprised if you have some numbness in the abdomen below the site of the new kidney or down into the thigh. This numbness is not unusual. It occurs in some patients. Some numbness is caused by the pressure of swelling in the abdomen on the nerves and should disappear in a few days or weeks. Occasionally, that feeling of numbness stays with you but has no effect on the ability to stand and walk. For the first few days, it will seem like someone wants to draw your blood every time you blink. Not really---but blood tests are needed frequently and are truly necessary. These tests are used to monitor reactions of the body to the grafted kidney and the effectiveness of medications used to prevent its rejection. Such blood tests are used to check glucose, sodium, potassium, BUN, creatinine, and CYCLOSPORINE levels in the blood. Temperature, pulse rate, and blood pressure are checked every two (2) hours for the first twenty-four (24) hours and every six (6) hours after that. All stools (bowel movements) must be checked for blood! You will be required to sit, stand, and walk as quickly as possible. You will get out of the bed and walk on the first day after surgery. It will hurt to move for a few days but you must move to prevent complications in the blood vessels and lungs. You will be asked to use TRIFLO breathing device to encourage you to take deep breaths, which help clear fluid from your lungs. Remember, you are a very special person. All of this close attention is provided to assure that you have the best possible recovery form surgery and to give you and your new kidney the best possible chance to become mates for life. Some rejection episodes are to be expected and we just have to treat them. Some rejection of the kidney can begin very soon after surgery or many years after a transplant. Many rejections are mild, temporary, and successfully treated with medication adjustments. Early recognition is important and signs or symptoms of rejections should be reported promptly to the nurse and doctors who are caring for you. You should report any of the following: Fever Increase in blood pressure Decrease in urine output Sudden weight gain (2-3 lbs. in a day or 6-7 lbs. in a week) Pain over or around the kidney Swelling of the hands and feet A noticeable loss of energy PREPARATION FOR DISCHARGE HOME: All of the pieces of equipment you accumulated during surgery will be removed, as they are no longer needed. You will probably not need the oxygen but a short time after surgery. The N/G tube to your stomach will be removed when you are ready to eat and move food through your digestive system normally. The central line in your chest to measure fluid levels will be removed in a few days, but as soon as it is removed you must begin getting up to void urine every 2 hours. This is mandatory. The IV in the arm and the TRIFLO breathing device will probably stay with you the longest. Even when you are eating well, as l ong as you are receiving IV medications, the IV will stay in the arm. Using the TRIFLO every day can improve your lung clearance and capacity. In other words, it is good for you. If you have no serious complications during your hospitalization, you could be out of the hospital in 7-10 days. Some problems may require a little longer. You should be returning to your normal routine several weeks after transplantation. You will find that you have more energy than you did before surgery. Of course, recuperation after surgery takes a while and your restrictions will include; no driving for six (6) weeks and no strenuous activity. But, you will find while you are in the hospital, you are making new friends, finding people to help you all along the way, and having the adventure of a lifetime. This paper was prepared to provide information to patients who are planning to receive kidney transplants under the care of: EAST CAROLINA UNIVERSITY SCHOOL OF MEDICINE, Transplant Service at PITT COUNTY MEMORIAL HOSPITAL Greenville,N.C.