Kidney Matters - Issue 9 Summer 2020

6
It’s a weighting game.
Why size matters in chronic
kidney disease
Should carrying a few extra kilos on the hips or around the waist have any bearing
on our suitability for transplantation? Kidney Matters asked Karen Stevenson,
a Consultant Renal Surgeon in Glasgow, if a patient’s weight influences her
decision to perform transplant surgery.
FEATURE INTERVIEW
In terms of weight and body shape, there are two main
practical considerations we have to make as surgeons
when we are assessing a person’s suitability for a kidney
transplant. As technology develops and more surgery
using robots is carried out, this may well change, but
currently we need to ask ourselves two questions:
• Can we place adequate separation or retraction 1
to expose the iliac vessels (the blood vessels at the
top of the leg) and bladder?
• Can we safely access the iliac vessels to place
clamps to control them?
Getting a good view of that iliac vessel
The transplanted kidney’s (or graft’s) artery needs to
be joined together (anastomosed 2 ) to the external iliac
artery and vein in the recipient. The iliac vessels lie just
on top of the muscles of the back of the abdominal
cavity. The small and large intenstines lie in front of
them. In order to access the iliac vessels, a cut or
incision is made through the front of the abdomen. If
a potential recipient carries a lot of weight around their
abdomen the distance to their iliac vessels is greater
and this makes the vessels more difficult to access.
Surgical safety rules!
We need to keep you safe. During surgery, we need to
ensure that the placement of the retractors we need
to use does not compromise other organ systems.
Whenever we put retractors into your body, they
increase the pressure on the respiratory system and
this impacts upon your ability to breathe and get
enough oxygen during an operation. The key is we
must be able to anaesthetise you safely.
Karen Stevenson, Consultant Renal
Surgeon, Greater Glasgow and Clyde
NHS Trust
kidneycareuk.org