Hyderabad Apollo Hospitals, Hyderabad, performed a Complex Combined Liver and Kidney Transplant, using organs from two different living donors, for the first time in India. The Complex surgery was performed by Dr Manish Varma, Chief Transplant Surgeon; by Dr Ravi Andrews, Consultant Nephrologist and Dr Naveen Polavarapu, Chief Transplant Hepatologist at Apollo Hospitals, Hyderabad, on a fifty-seven-year-old Tanzanian patient, Gabriel Ceaser Sisa. The uniqueness of the case was further compounded by the usage of a blood group mismatched organ, the liver. That made the task extremely perilous, but the hands-on experience and the immense expertise, the Transplant and Support Teams at Apollo Hospitals command, steered the outcome to success. The patient has since recovered and is all set to be discharged.
This case is unique, as it is the first time in our country that a multi-organ transplant has been performed using one organ that is mismatched blood group and the other organ of a matching blood group. Monitoring such patients, especially for rejection is a big challenge. As it is, blood group mismatched transplant of a single organ is a complex endeavor, undertaken only in select centers globally. It is noteworthy that the same team had performed the first mismatched blood group transplant of the city about six months ago.
Gabriel Ceaser Sisa first visited Dr Naveen Polavarapu, Apollo Hospitals, Hyderabad in 2017 with Liver related problems. It soon transpired that he had chronic Liver and chronic Kidney disease. Over the course of the next three years his Liver and Kidney diseases progressed despite being on active medical treatment and close monitoring. As he reached end stage Liver disease and end stage Kidney disease requiring hemodialysis, he was advised to undergo a combined liver and kidney transplant. Usually, such transplants are performed using organs from a single cadaveric donor, which avoids complications associated with multiple living donors including blood group mismatch, post-surgery donor recovery etc. In fact, rejection of the blood group mismatched organ by the recipient is very high and is an immense challenge, needing constant monitoring.
This patient being a foreign national was ineligible for a cadaveric organ in India and only Indian citizens can avail cadaver organs as per the law. The doctors had no choice but to harvest organs from two different donors from the patient’s family. Though his brother and nephew accompanied him as possible blood group matching donors for liver and kidney respectively, the brother was found medically unfit to donate either liver or kidney. The search mounted for a same blood group liver donor turned out to be futile. It was his fifty-two-year-old wife with a different blood group was the option on hand and a slice of liver was sourced from her and the twenty-nine-year-old nephew donated kidney.
He was admitted on February 9th, 2021, though preparations, administering special medicines and conducting various procedures as a part of the treatment protocol was begun three weeks ahead of surgery. The surgery, done on February 12th, 2021, took 23 hours, with three teams of surgeons operating simultaneously in three operation theatres. The kidney donor was discharged on the fourth day, liver donor on the sixth day and the recipient after sixteen days after the surgery on February 28th, 2021. The patient and both the donors are healthy and ready to fly back home.
The challenges faced by the medical team were enormous because of multiple health and procedural complications. The patient had to be prepared for blood group mismatched transplant, which required special treatment protocol. This surgery itself was a high risk because of multiple reasons like blood group mismatch, patient on dialysis, dual organ transplant and both organs from living donors, says Dr. Manish Varma, Chief Transplant Surgeon, Apollo Hospitals, Hyderabad.
The expert team of doctors was supported by Dr Ravi Andrews, Consultant Nephrologist; Dr K. Soma Sekhar, Consultant Gastroenterologist; Consultant Transplant Surgeons Dr Sasidhar Reddy and Dr Rajshri; Dr Manjunath B, Consultant Anesthetist and Dr Navakanth, Consultant Intensivist, among others.
This patient has to be on regular and lifelong medicines and undergo tests at regular intervals to constantly monitor both the organs. He needs to take additional precautions from the COVID perspective too.
“This is a very rare and unique case of it’s kind particularly because of the blood group mismatch and the complex combined Liver and kidney transplant done successfully on the same patient. Even on thorough literature search by our medical team only one such case was done earlier in the world. This required meticulous planning and execution and it wouldn’t have been possible without the efforts of our multidisciplinary team. We are happy to see that the patient is going back to his country safely after a successful outcome” says Dr Naveen Polavarapu, Chief Transplant Hepatologist, Apollo Hospitals, Hyderabad.
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