Complications of donor and recipient

The anesthesia and blood transfusion complications are common to both donor and recipient surgery. Recent advances in anesthesia management and contemporary techniques and training have drastically reduced the risk of anesthetic complications.

Risks of general anesthesia

  • Pain.
  • Sore throat.
  • Nausea and vomiting - up to 30% of patients.
  • Damage to teeth - 1 in 4,500 cases.
  • Anaphylaxis to anesthetic agents – in about 0.2%.
  • Aspiration pneumonitis – 1 in 900 to 1 in 10000
  • Awareness during anesthesia - up to 0.2% of patients; higher in obstetrics and cardiac patients
  • Backache.
  • Headache.

Rare complications

  • Cardiovascular collapse or worsening of existing cardiac ailments
  • Respiratory depression.
  • Hypothermia.
  • Hypoxic brain damage.
  • Nerve injury - 0.4% in general anesthesia and 0.1% in regional anesthesia.
  • Embolism - air, thrombus, venous or arterial.
  • Pneumothorax related to central line insertion.
  • In rare instances, complications other than those described above, including death may occur

Risks of blood transfusion

  • Allergic reaction 
  • Breathlessness
  • Low blood pressure
  • Nausea
  • Fever with chills and rigors
  • Immune hemolytic reaction where the body reacts to the transfused cells releasing substances into the body causing fever, chills, chest pain, back pain and dark urine
  • Transfusion related acute lung injury
  • Blood borne infections like HIV, Hepatitis B or C

Complications of donor surgery 

  • Bleeding 
  • Infection of the wound and other systems
  • Urinary leak through the wound 
  • Hernia in the scar
  • Any of the above conditions in rare cases may lead to death

Complications of recipient surgery 

  • Bleeding
  • Wound infection
  • Obstruction to flow of urine
  • Fluid collection around the graft
  • Clotting of blood vessels that are connected to the donor kidney
  • Urinary leak may occur through the site where the ureter joins the bladder. This will need a surgery to repair it
  • Narrowing of the artery which connects the kidney to the donor kidney leading to intractable hypertension. This may require an insertion of a small metal tube called a stent to widen it.
  • Narrowing of the ureter due to blood clot can occur soon after surgery or it can happen many years later due to scarring
  • Hernia in the scar
  • Any of the above conditions in rare cases may lead to death.

Medical complications involving the transplanted kidney

Hyper-acute rejection: Can occur in the operation theatre itself, in-spite of all mandated precautions.

Acute rejection: Can occur from days to years after a successful transplant

Chronic rejection: Can occur several months to years after a successful transplant.

Some of the above conditions may necessitate re-surgery once or several times to try to save the graft. Sometimes it may become necessary to do a graft biopsy or even to remove the graft, to save life. The patient may then have to go back on dialysis and plan either a second transplant or a life on dialysis alone.

Complications due to medications prescribed post-surgery like cyclosporine, azathioprine, steroids, ATG, ALG, rituximab and tacrolimus

  • Infections like tuberculosis, pneumonia, brain infections, urinary infection, liver infections, etc., can occur. Some of these infections could be life threatening
  • Hypertension (High B.P)
  • Heart Attack
  • Diabetes
  • Cancer due to immunosuppressive drugs
  • Loss of transplanted kidney due to BK virus infection

 

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