A 41-year-old man, with chronic kidney disease and severe hypertension, recently underwent a renal transplant at the Madras Medical Mission. The man’s body now houses five kidneys, including his own damaged kidneys.
Hospital authorities said the transplant was a mammoth task as his body cavity already had four kidneys. The patient approached vascular and transplant surgeon S. Saravanan as his first and second kidney transplant had failed due to uncontrolled hypertension. He was also diagnosed with coronary artery disease for which he underwent a triple bypass surgery three months earlier at the hospital. Dr. Saravanan performed the surgery on July 10.
In a transplant, the donor kidney is placed next to the native kidney and the renal artery is attached to the external celiac artery (a branch of the aorta, the biggest artery arising from the heart). The renal vein is attached to the external celiac vein and the ureter to the bladder. The blood vessels are usually present behind the intestine in retroperitoneum.
The old kidneys could not be removed as the patient could then profusely bleed and require blood transfusion, leading to production of antibodies that could cause rejection of the new kidney.
“There were four challenges in performing the surgery — lack of space for the new kidney in the retroperitoneum; lack of width in the native blood vessels to connect the renal artery and vein; the scarred bladder due to earlier surgeries; and the patient’s tendency to develop a lot of antibodies from the earlier surgeries, for which plasmapheresis (filtering of blood) has to be performed before the new kidney is placed,” Dr. Saravanan explained.
The surgeon decided to let go of the branches of the aorta and connected the renal artery at the bifurcation of the aorta and the renal vein to the inferior vena cava (the largest vein going to the heart).
Unconventional method
Unlike in the conventional approach, the kidney was placed high in the abdominal cavity next to the intestine.
“The transperitoneal approach is rarely performed even globally. It is what saved the day for my patient. This is such an uncommon surgery that I am yet to see a paper published in India on this,” the doctor said.
The patient has gone through his first set of post-operative check up and is recovering well, a hospital release added.
