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Case Reports: Novel treatment (new drug/interventions; established drug/procedure in new situation)
Youngest en-bloc kidney transplant recipient in India: defying the barriers and challenges with teamwork
  1. Jagadeep Ajmera1,
  2. Manjunath Maruti Pol1,
  3. Arvind Bagga2 and
  4. Aditi Sinha2
  1. 1Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
  2. 2Pediatrics, All India Institute of Medical Sciences, New Delhi, Delhi, India
  1. Correspondence to Dr Manjunath Maruti Pol; manjunath.pol{at}gmail.com

Abstract

We received a call from a transplant coordinator about the availability of a consented deceased donor. En-bloc kidneys with the aorta and IVC (inferior vena cava) were harvested from a toddler weighing 8 kg. The recipient was of early childhood weighing 14 kg who had been on haemodialysis for the last 3 years for end-stage kidney disease. He received anti-thymocyte globulin as an induction immunosuppressant. The kidneys were transplanted en bloc in the right lower quadrant retroperitoneal region; an anastomosis was performed to the recipient’s aorta and IVC, and two separate neocystoureterostomies were created. His serum creatinine reached 0.5 mg/dL on the seventh postoperative day, following a few days of delayed graft function. In this study, we describe the surgical and non-surgical challenges that we faced while performing en-bloc kidney transplant to the youngest recipient and how a multidisciplinary team approach helped us overcome them.

  • General surgery
  • Transplantation
  • Renal transplantation
  • Chronic renal failure
  • Dialysis

http://dx.doi.org/10.1136/bcr-2022-254439

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    Footnotes

    • Twitter @Aditisinha04

    • Contributors Dr Sai Kaustubh and Md Fawaz were involved in donor surgery along with JA and MMP. Dr Srinivas, AB and AS admitted the recipient and prepared him for the surgery. JA, Md Fawaz and Dr Srinivas did preoperative workup. Dr Sai Kaustubh, Md Fawaz, Dr Arun, Dr Ratnakar, Dr Ravi Ranjan, MMP and JA were scrubbed in the recipient’s surgery. JA, AB, AS and MMP were involved in the postoperative care of the recipient. JA and Dr Sai Kaustubh compiled the case report. JA, Dr Ratnakar and MMP did the literature review. JA compiled the final case report, which was edited by MMP. AB, AS and MMP were involved in further follow-up of the patient. The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content—JA, MMP, AB and AS. The following author gave final approval of the manuscript—MMP.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.