Organ Donation and Transplantation
The first renal transplantation in Cyprus was performed in 1986 by Dr Kyriakides in Paraskevaidio. Since then, a lot of expertise was gained both in kidney donation and living donor kidney transplantation. Currently, kidney transplants are the only solid organ transplants performed in the transplant clinic in Nicosia General Hospital. The department has a dedicated staff including transplant nephrologists, transplant surgeons, coordinators, high qualified nursing staff and experienced histopathologist. About 20 kidney transplants are performed every year in the center.
Dr Papoulas is a liver, kidney and pancreas transplant surgeon. Since July 2020 he is working as a transplant surgeon in the Nicosia General Hospital. He has performed the first purely laparoscopic donor nephrectomy in August 2020. Since then, this method is considered the standard of practice for all potential kidney donors. His vision is to establish an Organ Transplantation Unit in Cyprus for liver, kidney and pancreas transplantations. Currently, all Cypriot patients who need liver transplantation are referred abroad. Dr Papoulas can manage the surgical care of post-liver transplant patients using his expertise and excellent network with international transplant centres in UK and Israel.
Laparoscopic Donor Nephrectomy
Laparoscopic donor nephrectomy is the current standard of practice approach for all potential kidney donors. It is performed through 3 tiny incisions in your abdomen while. At the end of the procedure, the organ is removed though a small 6cm incision in the lower abdomen.
Compared with the large incision operation used in the past, laparoscopic surgery is associated with quicker recovery, shorter hospital stay and less pain. Many kidney donors return to their normal activities or job within a few weeks of donating a kidney.
The laparoscopic procedure will be described in detail in a consultation before the planned surgery date. The operation usually takes about three hours. Most donors who undergo laparoscopic nephrectomy require a hospital stay of only two or three days. Once the donor leaves the hospital, he or she will be seen for follow-up care in the transplant clinic. Dr Papoulas performed the first purely laparoscopic donor nephrectomy in Cyprus in August 2020.
Figure 1. Purely Laparoscopic Right Donor Nephrectomy using three tiny holes and a small Pfannenstiel incision for the extraction of the kidney.
Kidney transplant provides the best long-term outcome for patients with end-stage kidney disease. The kidney may come from a cadaveric donor or from a living donor.All patients with end-stage kidney disease should be considered for a transplant. Age is not a major determinant of outcome but the presence of comorbid disease adversely affects survival.
Patients do not generally have their native kidneys removed and the transplanted kidney is placed extraperitoneally in theiliac fossa.A kidney transplant generally takes three to four hours.The blood vessels of the donor kidney are attached to your blood vessels and the ureter (the tube which connects the kidney to the bladder) is joined to your bladder. A small plastic tube called a stent is placed inside the ureter to make sure you are able to pass urine. The average length of stay is 7-10 days. Between four and six weeks after your transplant the stent is removed under local anaesthetic as a day case procedure, with no need to stay overnight in hospital.
Patients require frequent follow-up after discharge (two or three times each week initially). Lifelong immunosuppression is required to prevent rejection. Long term follow up is also imperative, including annual screening for cancers, drug toxicity and cardiovascular disease.
A formal and informative discussion will be done prior to transplantation with your transplant surgeon regarding the benefits of transplantation, the risks and complications (early and late) following kidney transplantation.
Image 1. Kidney transplantation to the right iliac fossa.