Successful Kidney Transplantation in a 29 Y.O. Female from Madagascar
PACE Hospitals' Kidney Transplantation team successfully performed an ABO Incompatible Kidney Transplant on a 29-year-old female from South Africa, who was suffering from chronic kidney disease (CKD Stage 5D) secondary to suspected chronic glomerulonephritis. The aim of the procedure was to restore adequate kidney function, improve her quality of life, and eliminate the need for long-term dialysis.
Pace Hospitals, provides extensive and highly notable quality of living donor and deceased donor kidney transplant. The department is backed up with multidisciplinary team of kidney transplant and dedicated kidney transplant ICU (intensive care units) that help to accomplish complex and complicated surgeries with high success rates.
Our team of kidney transplant surgeons, transplant nephrologists and kidney specialist doctors are highly qualified in performing complex surgeries and organ transplants and, they are having extensive experience to perform the surgery with accuracy and precision. The transplant team is backed up with the World’s First Universal Surgical Robotic System, the latest laser treatment equipment, a state-of-the-art facility and modern technology offering comprehensive treatment.
The patient had chronic kidney disease diagnosed in 2021, when she was presented with weakness, joint pains, anemia, and was found to have markedly elevated creatinine with a negative autoimmune workup. Her disease progressed to end-stage renal disease, and she had been on maintenance hemodialysis three times a week. She experienced multiple AV fistula failures and required a permacath for dialysis access.
She was a known hypertensive. After arriving in India, she developed a right-sided pleural effusion with fever, which was diagnosed as pleural tuberculosis, for which she received Anti-tubercular Therapy (HRZE) for two months followed by isoniazid and moxifloxacin in the continuation phase.
On general examination, the patient showed no pallor, icterus, or pedal edema. Vital signs revealed an abnormal blood pressure and a normal pulse rate. Systemic examination showed normal heart sounds on cardiovascular assessment, normal vesicular breath sounds on respiratory examination, and a soft, normal abdomen on palpation.
Upon admission to PACE Hospitals, the patient underwent a comprehensive evaluation by the kidney transplant surgeons, including a detailed clinical examination and review of medical history. She presented with end-stage renal disease (CKD Stage 5D) and was planned for an ABO-incompatible living-related kidney transplantation.
Immunological and serological studies, including blood grouping, HLA typing, crossmatch (CDC and flow cytometry), and isoagglutinin titers, were performed. The donor was her father (B+) and the recipient was O+, confirming the need for desensitization prior to transplantation. Anti-B titers were elevated pre-procedure.
Radiological evaluation, including chest X-ray, renal ultrasound, and Doppler studies, showed a stable preoperative status with no contraindications for transplantation. Cardiovascular assessment and ECG findings were within normal limits.
Laboratory investigations revealed anemia and leukopenia. Renal and liver function tests, serum electrolytes, coagulation profile, and other metabolic parameters, including blood sugar, TSH, Vitamin B12, and glycosylated hemoglobin, were within normal limits.
Based on the confirmed findings, the patient was advised to undergo Chronic kidney disease (CKD Stage 5D) treatment in Hyderabad, India, under the expert care of the Kidney Transplantation team.
After a detailed consultation with a team of kidney transplant surgeons, Dr. A. Kishore Kumar, Dr. Vishwambhar Nath, Dr. Abhik Debnath, and Dr. K Ravichandra, a comprehensive evaluation was performed to determine the most appropriate therapeutic approach.
The patient presented with end-stage renal disease secondary to long-standing hypertension and had been undergoing regular hemodialysis. A living-related donor was identified, but the donor-recipient pair was ABO-incompatible, requiring a tailored pre-transplant desensitization protocol.
Imaging and laboratory evaluations, including renal ultrasonography, echocardiography, and detailed serological testing, were reviewed. Baseline hematological, biochemical, and coagulation parameters were within acceptable limits for transplantation. Infectious screening was negative, and no additional systemic contraindications were identified.
Based on clinical assessment and investigations, it was determined that the patient had chronic kidney disease stage 5, responsible for her symptoms. ABO-incompatible living donor kidney transplantation with pre-transplant desensitization was identified as the most suitable definitive intervention to restore renal function, reduce dependency on dialysis, and improve long-term quality of life.
The patient and family members were thoroughly counselled regarding the complexity of ABO-incompatible kidney transplantation, the desensitization regimen, potential risks including rejection and infection, and the anticipated postoperative course with long-term follow-up.
Following the clinical decision, the patient was scheduled for an ABO Incompatible Kidney transplantation Surgery in Hyderabad at PACE Hospitals, under the expert care of the Kidney Transplant Department.
The procedure involved the following steps:
Donor Kidney Harvest (Laparoscopic Left Donor Nephrectomy): The left kidney of the father was harvested laparoscopically. Intraoperative findings included a single renal artery, single renal vein, and single ureter. The kidney was flushed and preserved in cold preservation solution before being transferred to the recipient table.
Recipient Positioning and Right Iliac Fossa Exposure: The recipient was placed in a supine position, and the right lower abdomen (right iliac fossa) was prepped and draped. A right iliac fossa incision was made, and the retroperitoneal space was entered. The external iliac vein and internal iliac artery were carefully dissected, looped, and prepared for anastomosis.
Venous Anastomosis: The donor renal vein was oriented and positioned in the right iliac fossa. An end-to-side anastomosis was performed between the renal vein and external iliac vein using vascular sutures. Venous clamps were released to confirm good venous outflow and hemostasis.
Arterial Anastomosis: The donor renal artery was then anastomosed end-to-end or end-to-side to the internal iliac artery, as documented. After completion, the arterial clamps were released, allowing graft perfusion. The kidney was observed for pink color, turgor, and immediate urine output, indicating adequate perfusion.
Ureteric Implantation: The donor ureter was tunneled to the bladder, and a ureterovesical anastomosis was performed using an anterior extravesical, non-refluxing technique (modified Lich–Gregoir). A Pandey stitch was placed at the apex of the anastomosis to create a submucosal tunnel and prevent reflux. A DJ stent was inserted for later removal, as per the discharge plan.
Hemostasis, Drain, and Wound Closure: The graft position in the right iliac fossa was confirmed, and hemostasis was ensured. A drain was placed near the graft as required. The abdominal wall and skin were closed in layers.
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