For the first time in India, a minor organ donor’s both kidneys were transplanted into a five-year-old child. The procedure, known as en bloc kidney transplantation (EBKT), was performed at the All India Institute of Medical Sciences.
The transplantation of two kidneys from the same paediatric donor, as well as blood vessels, the vena cava and aorta, into a single recipient, is known as EBKT. Normally, the organs of a child donor are given to adults, and this process has so far only occurred between a paediatric donor and an adult.
The patient’s iliac vessels were of smaller calibre and insufficient for revascularization due to growth retardation. As a result, the donor’s aorta was linked to the recipient’s aorta, as was the donor’s inferior vena cava to the recipient’s, which the hospital administration describes as a rare achievement.
Recipient also paediatric
“This is for the first time that the recipient was also a paediatric, making the entire transplant procedure complicated and rare,” said Dr Manjunath Maruti Pol, associate professor, general surgery, kidney transplantation surgery and vascular surgery, AIIMS. “The recipient, a five-year-old boy, was suffering from growth retardation owing to failed kidneys and because of this, his blood vessels weren’t properly developed. The child was so small that his limb blood vessels were not adequate enough to join the graft kidney vessels with the recipient’s existing blood vessels. So, we had to transplant the boy’s major vessels, the aorta and IVC, as well.”
While the aorta is the main artery that transports blood from the heart to the rest of the body, the IVC is a large blood vessel that transports deoxygenated blood from the lower extremities and abdomen to the heart’s right atrium.
The donor is a 16-month-old child who donated all his organs on August 25. Both the donor’s kidneys were transplanted into a five-year-old boy on the same day. “The recipient is so young that the anaesthesia team wasn’t even able to find the blood vessels of the child. It took one and half hours for them to locate the vessels,” said Pol.
Risky operation
There were numerous difficulties in carrying out the surgery.
Transplantation involving small-calibre vessels carries a high risk of thrombosis, which can result in graft kidney failure and failure to function. Another issue in this case was the donor ureter’s short length and underdeveloped urinary bladder, which meant that any linking of blood vessels performed under tension would fail, resulting in leakage.
Furthermore, small-sized stents and three-way catheters were difficult to obtain because they are not widely available on the market. In addition, if haematuria (blood in the urine) occurs, the two-way catheter will become blocked, resulting in anastomosis leakage.
Following the transplant, Pol exulted, “After this procedure, the child will have a normal life. The quality of life will improve and the patient can soon go to school even.” The recipient has been discharged from hospital and now is fit and healthy.
The whole procedure required professor Sandeep Aggarwal, head of surgery unit 2, professor Seenu, nodal officer for kidney transplant surgery, and professor Sunil Chumber, head of department of surgery, to be in the surgical team. Peri-operative critical care was provided by professor Arvind Bagga, head, department of paediatric nephrology, and his team.
