The transplanted kidney is almost always placed into the pelvis. Three connections are required – artery to artery, vein to vein, and ureter (drainage tube from the kidney) to bladder. It is reasonably common for there to be more than one artery in which case a further join is required.
For someone who has never had pelvic surgery or a transplant previously then technically the surgery is generally straightforward. It becomes more complex though in people who have had a lot of surgery before, or in patients who have been on dialysis for a long time as there can be such ‘hardening’ or calcification of the arteries it may not be possible to be able to get a transplant ‘plumbed in’. The length of the operation therefore can vary but typically takes about 3 hours.
Every patient returns from the operation attached to a number of leads and tubes! Everyone will definitely have a catheter going into the bladder, and it will typically stay in place for five days. This keeps the bladder empty to allow the join between the new kidney drainage tube (ureter) and the bladder to heal before there is any stretch or pressure. There will also be at least a couple of drips in the arm and perhaps a larger one in to the neck vein. These allow fluids and drugs to be given, and will be removed in the first two or three days after the operation. Some people will have a plastic drain coming from the abdomen near the new kidney, which is removed in the first few days.