Transplant Procedure

The transplant procedure has previously been described.2 Recipients are brought to the operating room normothermic and euvolemic. Monitoring devices are placed and include ECG, pulse oximeter, rectal or oral temperature probe, and arterial line. Using flouroscopic guidance, a large, double lumen central line is placed. This is used for monitoring and administration of fluids and blood products intraopera-tively and, if necessry, dialysis postoperatively. The abdomen and pelvis are prepped and draped and the Foley inserted on the field. The bladder is filled by gravity with antibiotic solution and the Foley clamped. Children < 16 kg are explored through a midline incision. The right colon is mobilized and control of the aorta, vena cava, and iliac arteries and veins obtained. If indicated, the native kidneys and ureters are removed. The aorta and vena cava are occluded with a single vascular clamp and the iliac arteries and veins controlled with vessel loops. The renal artery and vein are anastomosed to the distal aorta and vena cava using 7-0 and 60 prolene, respectively. Before reperfusion, the child is given 250 mg/kg of manni-tol, 1mg/kg of furosemide, 1 mg/kg of sodium bicarbonate, and the CVP raised to 15 cms of water. The venous clamp is removed first followed by the arterial. The graft is bathed in warm saline and bleeding controlled with cautery and suture ligatures. The ureteral anastomosis is done using the Leadbetter-Politano technique. A double or single J ureteral stent is placed in the pelvis and the proximal end either in the bladder (double J) or brought out through the urethra and secured to the Foley. Children > 16 kilograms undergo an extraperitoneal approach.

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