5-yr-old becomes India's youngest En-Bloc Kidney Transplant recipient

By Shalini Bhardwaj
New Delhi [India], September 16 : A 5-year-old boy has become the youngest Indian to undergo en-bloc kidney transplant surgery in the country at the All India Institute of Medical Sciences (AIIMS).
The donor of a 5-year-old was a 16-months-old boy who was declared brain dead at AIIMS and his organs were donated to save the lives of others.
"The recipient 5-year-old boy with 13 kg weight was suffering from an autoimmune disease that affected both his kidneys. He had been suffering from chronic kidney failure for a long duration and was continuously on haemodialysis," Dr Manjunath Maruti Pol, Additional Professor, Department of Surgery, AIIMS told ANI.
"Surgery is technically challenging in children due to small-calibre vessels that are prone to blockage (a/k/a thrombosis), leading to graft kidney failure that ceases to function. A small length of donor ureter and underdeveloped urinary bladder: An anastomosis performed under tension would break down, leading to leakage. Additionally, there is difficulty in getting small-sized stents and three-way catheters, as they are not readily available in the market. Incidentally, if haematuria (blood in the urine) occurs it will lead to blockage of the two-way catheter and anastomosis leakage," said Dr Manjunath while explaining about challenges and complications in such surgeries.
He further said there is a very narrow window for error in these en-bloc transplant surgeries involving anastomosis of vessels in children.
"As the blood volume in children is minimal, the paediatric patient would not tolerate a blood loss of more than 20 per cent of their blood volume (e.g., it was approximately equal to 300 ml in this child). Furthermore, a delay in revascularization would lead to an increase in cold ischaemia and warm ischaemia time, resulting in graft dysfunction. Diuresis after surgery can cause electrolyte disturbances, which can lead to seizures, altered sensorium, and other complications. The dose of immunosuppression has extensive inter-and intra-individual variations," Dr Manjunath added.
En-Bloc Kidney Transplant occurs when the two moieties (kidneys), from the same small pediatric donor), along with the aorta and inferior vena cava (IVC), for graft revascularization are transplanted into a single recipient.
Typically, during transplantation, the proximal (suprarenal) part of the donor aorta and IVC are surgically closed (that is, over sewn or stapled) and the distal segment of the donor aorta and IVC are anastomosed to the iliac vessels.
"However, in our case, due to the growth retardation in the child, the patients' iliac vessels were of small calibre (inadequate for revascularization); therefore, donors' aorta was anastomosed to recipients' aorta and donors' IVC was anastomosed to recipients' IVC," he explained about the challenges involved in such surgeries.
"It is teamwork, and we worked in teams and the surgical part, in this case, was taken care of by Dr Manjunath Maruti Pol, and the team. Prof. Sandeep Aggarwal (Head of Surgery unit-2), Prof. Seenu (nodal officer for kidney transplant surgery) and Prof. Sunil Chumber (The Head Department of Surgery) have been continuously encouraging, guiding and providing all support necessary for transplant surgery. The peri-operative critical care was provided by the Head Department of Pediatric Nephrology's Prof. Arvind Bagga and his team," AIIMS said in statement.