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A rare & complicated kidney transplantation performed at K.G. Hospital & Post Graduate Medical Institute, Coimbatore
Kidney transplantation is a boon to patients with chronic (permanent renal failure). Ten years back, patients had to go outside the country for kidney transplantation or to selected few centres in the country. The success rate of kidney transplantation was less than 50%.
Thanks to the developments in the medical field. The success rate of the kidney transplantation is almost 95% at the end of 1 year. In spite of all medical advancements, the kidney transplantation surgery could fail. Rarely, the transplanted kidney could stop functioning on the operating table itself. This complication is called as HYPER ACUTE REJECTION, where the patient's immune system rejects the transplanted kidney in no time. This hyper acute rejection happens to one in one lakh transplant surgeries.
Mr. Muthuraj, a 35-year old ex-serviceman, was having on and off headache that he neglected. One day when he developed vomiting, he was hospitalized. Evaluation revealed that he had high blood pressure with severe kidney failure and was started on dialysis. Considering his age, he was advised kidney transplantation. His brother was willing to donate one of his kidneys and he underwent renal transplantation surgery elsewhere in the year 1999. The kidney became blue within 5 minutes of surgery and stopped functioning due to HYPER ACUTE REJECTION. The transplanted kidney was removed immediately. Then he was taken up on haemodialysis again.
In the year 2000, again the family decided to make another attempt of transplantation. Mr.Muthuraj's cousin donated his kidney, and he got his second transplantation surgery done in another centre. Unfortunately, this kidney also was rejected immediately due to hyper acute rejection. He was back on haemodialysis again. Meanwhile, he was made medically unfit by his employers and was left with his own support for treatment.
As continuing dialysis life long was impossible and he was also young, the family decided to go in for a third transplantation accepting the risks. They approached various hospitals for the same. As there were two hyper acute rejections, the third transplantation was refused everywhere, because the chances of the third kidney getting hyper acute rejection were almost 100%.
He finally came to K.G. Hospital & Post Graduate Medical Institute, Coimbatore. The family requested to go ahead with the third kidney transplantation, as successful kidney transplantation was the only life saving treatment available. Hence a written consent was obtained and the requisite tests were conducted. His aunt was identified as his renal donor.
The problems were analyzed in detail by the transplant team doctors. Apart from routine pre-transplant precautions, special tests were performed, including 'B' cell cross match and 'T' cell cross match. The patient underwent plasma exchange to remove the pre-formed antibodies, received powerful immunosuppressive like Cyclosporine, Mycophenolic acid and Interleukin-2- receptor Antagonist and steroids. It was decided to take up this challenging kidney transplantation at K.G. Hospital. The renal transplantation was done on 23rd September, 2003. Fortunately, there was no hyper acute rejection and the kidney started functioning immediately.
This is for the first time in the history of Kidney Transplantation that such transplantation has been successfully carried out. For the past one-year, his renal functions are within normal limits and he is doing fine. Mr. Muthuraj and his family members expressed their gratitude to the entire transplant team of doctors and nurses for undertaking this type of highly complicated transplant surgery and making it a successful one.
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