5-yr-old youngest in India to undergo en bloc kidney transplant

A five-year-old boy has become the youngest patient in the country to undergo an en-bloc kidney transplant surgery at the All India Institute of Medical Sciences (AIIMS).

According to doctors who conducted the transplant, it was a challenging surgery as both the kidneys were taken from a 16-month brain dead child and transplanted to the five-year-old.

‘En-bloc’ approach helps transplant small kidneys. Under this procedure, instead of transplanting a single kidney, doctors keep both of the kidneys attached to the aorta and vena cava and attach the entire ‘tree’ – the two kidneys, the aorta and vena cava, sewn over at one end – onto the recipient. “It is not a new concept but has never been tried in children so far, and due to the risk involved, kidney transplantation in children is avoided,” said Dr Manjunath Maruti Pol, who led a team of doctors that conducted the surgery on the child.

He added that the surgery is challenging in children due to small caliber vessels that are prone to blockage (also known as thrombosis), leading to graft kidney failure that ceases to function.

“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,” Dr Manjunath said.

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He said there is a very narrow window for error in 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% of their blood volume. In this case, the child had 300 ml blood volume,” said Dr Manjunath.

According to Dr Sandeep Aggarwal, head of surgery unit-2 at AIIMS, who was overseeing the transplant surgery, the procedure went on for three hours and the patient was kept under observation for seven days, after which he was discharged. “He recently came for routine inspection and was found to be recovering well,” he said.

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