Our Services & Specialties
Renal Medicine / Dialysis at LBH
Sonal Mistry
The Renal Service comprises of a multidisciplinary team and include renal physicians (nephrologists), dialysis nurses, renal transplant and access surgeons who deal with surgical needs of dialysis patients and transplantations. The team also includes interventional radiologists who have expertise in the placement of dialysis catheters, renal biopsies, renal angiography and mangement of renal artery stenosis with balloon angioplasties and stenting.
Dialysis Unit
The dialysis unit at London Bridge Hospital was established a year after the hospital first opened in 1986 with 3 dedicated machines available. Over the years it has grown into a well developed, modern facility now comprising of 7 stations and an isolation room.
Patients can receive a high standard of care and treatment in comfortable surroundings lead by the Unit Manager and her team of specialist nurses. There is also a Consultant Nephrologist on site.
We provide dialysis for patients who are NHS sponsored as well as for overseas visitors who are in the country for business or pleasure. We do have facilities to dialyse patients who are Hepatitis B or C positive but please contact the unit for further information.
The Team:
Consultant Renal Physicians:
Dr Kamal Ahmed
Dr James Pattison
Dr Ian Abbs
Transplant & Access Surgeons:
Mr Geoff Koffman
Mr John Taylor
Mr Francis Calder
Dialysis Unit Manager:
Sister Helen Cronin
Renal Administrator:
Sonal Mistry
Renal Access and Transplantation
Introduction
Chronic kidney disease is an increasingly common problem and in the UK there are ~ 40,000 people with this condition who require some form of renal replacement therapy. Kidney transplantation offers a near normal existence and has been shown to improve survival and quality of life compared to dialysis therapy.
Dialysis Access Surgery
When the kidneys are not functioning properly the body accumulates waste toxins which you would normally get rid of in the urine. Dialysis refers to a process of ‘cleaning the blood’ and this is necessary for many people with chronic renal failure. The most important part of the whole procedure is how to remove the blood from the body. The best way of doing this is by creating a ‘fistula’. This normally involves an operation in one of your arms to join an artery and vein together to form a circuit of flowing blood. From this fistula circuit, the blood is sent to the dialysis machine.
The operation to form the fistula will usually take about one hour and can often be performed under local anaesthetic.
Kidney Transplantation
A kidney transplant is generally considered the best option for anyone with chronic renal failure-most people live longer than if they stay on dialysis and enjoy a better quality of life.
Your own kidneys can be found at the back of the abdomen and for most people with chronic renal the kidneys will shrink and do not need to be removed before a transplant. If however, they are causing problems e.g. pain bleeding, infection etc…then it may be necessary to remove them.
The transplant kidney is normally placed at the bottom of the abdomen, just above the hip. It is joined to the blood vessels that are travelling to the leg and also to the bladder. Blood passes through the kidney and is cleaned, the urine is produced as a result of the cleaning process. The urine travels from the transplant kidney into the bladder and you pass it out in the normal way.
The kidney transplant operation takes 3-4 hours and most people are in hospital for a week in total. After you have left hospital it is vital that you attend the outpatient department regularly so that we can monitor the functioning of the new transplant.
If you have already had a transplant that failed it is possible to have another one. Normally this is placed on the opposite side to the first transplant.
Live Kidney Donation
The best form of kidney transplant is from a Live Donor. This is someone who is fit and willing to give you one of their kidneys. In the absence of a close relative the partner and/or close friend can be considered provided that they are medically or immunologically suitable. Before they can donate a kidney we will perform a series of investigations on them to see that they are in excellent health and so the impact of the surgery and living with one kidney is minimal.
There are two methods of removing a kidney for transplantation. The traditional approach is to make a cut underneath the ribs and remove the kidney through this opening.
A newer method is to remove the kidney using 'keyhole' or Laparoscopic surgery techniques. This method is less painful and allows for a quicker recovery-see Laparoscopic Donor info.
Laparoscopic Live Donor Nephrectomy
This is a new surgical technique which has been developed in the 1990's and is now recognised as the optimal way to remove a kidney for transplantation.
What are the advantages?
Compared with the traditional (open) approach, laparoscopic donation results in less pain, fewer days in hospital, a faster recovery and return to normal health. In particular, the larger patient will benefit considerably from the laparoscopic approach. Additionally, the scars are cosmetically better.
Is everyone suitable for laparoscopic donation?
Laparoscopic surgery is recognized as being more complex than traditional surgery to remove a kidney. But our experienced surgeons are able to perform the laparoscopic operation in almost all patients.
What about the transplant?
There is no difference for the recipient between laparoscopic donation and traditional surgery. When performed by an experienced surgical team the donated kidney will have an excellent outcome for the recipient of the kidney-on average this form of transplant would last at least 15 years.
What about the donor’s remaining kidney
Before anyone can donate a kidney, they must undergo a series of tests to make sure that there will be minimal risk to their long term health. Laparoscopic donation allows a faster recovery and does no harm to the remaining kidney. However, it is necessary for the donor to have a simple blood/urine test each year and have their blood pressure checked.
The Operation
Before Surgery
All potential donors must undergo a thorough evaluation of their health before they can undertake kidney donation. This is to ensure that they will recover from the operation well and their long term health (with one kidney) will not be affected. As part of this process you will meet the surgeon who will perform the operation and he will talk to you in detail about how the operation will be proceed and what to expect afterwards. He will be delighted to answer any questions you have and reassure you over any worries.
Preparation for surgery
The day before the operation your surgeon will meet with you to check that everything is in order to proceed. If you are taking any medication, then continue this as normal. Eat and drink normally until midnight and then have nothing more once you have gone to bed. You will have a drip overnight which will stop you feeling thirsty and also ensures your kidneys are full of fluid before the operation.
The operation
The operation is performed under general anaesthetic and takes 3-4 hours. A camera and one or two small instruments are inserted through the side of the abdomen. These instruments are used to separate the tissues from around the kidney. The final part of the procedure is to divide and seal off the blood vessels. The kidney is then removed through an opening about the size of a hand below the umbilicus.
After the operation
Your surgeon will see you immediately after the operation. You can have something to drink straight away. Then you will return to the ward. The next day you will be out of bed and free from any drips etc…You can eat and drink as you feel like. Most people will leave the hospital on the third day after the operation.
After leaving hospital
Although the scars are small you will have had a major operation and your body will be recovering-so take it easy. Walking is recommended to speed your recovery but any strenuous exercise should be avoided. Your surgeon will review you again in the outpatient clinic in 4 weeks after the operation. Most people feel fully recovered at this point and are ready to return to normal life-driving, going back to work, resuming sporting activities etc…
Living Donor Kidney Transplantation at London Bridge Hospital
We employ the most experienced surgical teams (Guys GOS..)- in the UK to perform these operations. They have over twenty years experience in managing all aspects of kidney transplantation (including Laparoscopic Live Donor Nephrectomy) and are able to deal with the most complex problems in both adults.
