Doctors at Max Super Speciality Hospital, Delhi NCR’s leading healthcare provider, performed India’s first Orthotropic Renal Transplant surgery to save life of a 43-year-old retired police officer suffering from end stage kidney disease.
A team of doctors led by Dr Anant Kumar and his team Dr. Manisha Dassi, Dr. Shailendra Goel, Dr. Vimal Dassi, and Dr. Upwan Chauhan at Max Hospital, Vaishali performed the rare Orthotropic renal transplant.
The case was challenging and highly complicated and critical as the donor’s kidneys were dilated due to an aneurysm and the patient’s kidney was completely blocked with atherosclerosis.
The 43-year-old retired police officer, Mr Ajay Malik had been on hemodialysis and medications for almost three years due to Chronic Kidney Disease. As the disease was progressed, he suffered from atherosclerosis, which is commonly called as building up of plaque in the arteries. This narrowed his blood vessels in the upper and lower abdomen and the upper and lower limbs as well, requiring immediate renal transplantation.
His wife Mrs Rekha Malik wished to donate her kidney. However, upon detailed investigation, it was revealed that she has an aneurysm of size 20 X 15mm in her renal artery, making the case further complicated for transplant.
Due to narrow blood vessels and limited blood flow to the lower limbs, conventional kidney transplant was not possible. The team of doctors then decided to perform a very rare and unique transplant surgery known as Orthotropic kidney transplantation.
Before preparing for the transplant/kidney retrieval from the donor (patient’s wife), the aneurysm was completely removed and corrected. Since the abdominal aorta of the patient was also diseased, it was planned to anastomose renal artery to the splenic artery for revascularization. Patient renal vein was anastomosed with donor renal vein. Here donor and patient ureter were close to the kidney .
Explaining, Dr Anant Kumar, Chairman of Uro-Oncology, Robotic & Kidney Transplantation, Max Hospital said: “After consultation with the vascular surgery team, we decided to take up this complex case, where the donor’s kidney, as well as the recipient’s condition, was extremely critical and rare. The patient’s kidney was replaced by the transplanted kidney, in the same area. Complications such as the history of extensive surgery in the lower abdomen or extensive malformation of vessels of the lower abdomen, which can make routine transplant surgery difficult or entail higher complication rates. In such cases, the orthotropic renal transplant plays a vital role in stabilizing the post-op life of the patient towards better quality.”
The patient successfully underwent orthotropic renal transplant surgery via laparoscopy.
In this procedure, the donated kidney (graft) is placed in the same position as the native one (Orthotropic – this is deep-seated in the body), in contrast to the normal heterotopic procedure where the graft kidney is placed near the abdomen. Such complicated procedures are performed only in cases entailing higher complication rates and can only be performed by transplant surgeons having vast experience in transplant.
Unlike regular surgeries for kidney transplantation where the patient receives the kidney through a larger muscle-cutting process, robotic and Laparoscopic surgeries are conducted with only a small incision and involve no cutting of muscle. Blood loss during surgery and the scope for human error are also minimised.
The patient and the donor were discharged after 7 days of the transplant. The patient’s body accepted the transplant well.