Chennai based Kidney Transplant team comprising Dr Prabhu Kanchi Head of NEPHROLOGY and renal transplant ,Dr Swaminathan sambandam- Head , Department of multi organ transplant , Dr Rajasekaran Siddhan- Lead Laparoscopic and Robotic Uro Surgeon , surgical associate VP Vaseekaran , GEM Hospital chennai carried out what they claim to be the first ever cadaver kidney transplant for a patient just four weeks after Covid pneumonia. The team has successfully and safely carried out complicated transplants including RE transplants and blood group mismatch transplants during the pandemic.
Excerpts from the interview with the team
Why Kidney transplant? Why not just dialysis?
Advanced Kidney disease could be very deadly if not treated apropriately. Kidney transplants are not just life saving but life changing treatment modalities. Dialysis prolongs life but it's no match compared to a successful transplant. In fact, even thrice a week dialysis could match only 10 percent of a normal kidney function. Transplant is the best option available for advanced kidney problems as it brings back normal kidney functioning.
Why were kidney transplants stopped during Covid?
Transplant units across the globe stopped doing kidney transplants when covid pandemic started in March 2020. Although kidney transplants are life saving, specialists feared that Covid could be more severe in a transplanted patient. The anti rejection medications patients receive after the transplant keep their immune system suppressed. This potentially could make them more vulnerable to the disease. Also the knowledge about Covid-19 in the initial days was very poor. So it looked logical to put on hold all the kidney transplants at that point of time.
Tamilnadu is the only state where maximum number of cadaver transplants happen in india. Such a successful programme was stopped for the fear of Covid
Why did you restart kidney transplants during pandemic?
Our team took this very bold but conscious step of restarting the kidney transplant program as we realised that the kidney failure patients were not doing well even with adequate dialysis. These patients could actually be given a chance at prolonged better quality of life by going ahead with the transplant. Not all tolerate dialysis well, many of them deteriorate eventually. Only 50 percent patients survive 3 years on dialysis. We chose 10 such patients who were not doing well and decided to perform kidney transplants on them.
The continuous advances in understanding of the covid – 19 disease and its effective prevention methods such as Mask, social distancing and hand washes, helped us to chose this decision.
WHY and HOW did you do transplant for recent Covid PNUEMONIA affected patient ?
One of our patients, a 44 year old male farmer was waiting for a cadaver kidney for more than 18 months. He acquired Covid but sadly it was not just Covid but was a frank Pneumonia complicating it. He was hospitalised as he needed oxygen treatment. But luckily he recovered in a week and was discharged from the hospital. 3 weeks later we got an offer for a cadaver kidney from a young brain dead patient. We knew it was a golden opportunity for him, this would give him his life back. We were allotted this cadaver kidney after others in the City declined the same. After confirming he has fully recovered from Covid we went ahead with the transplant. He got better and got discharged in a week's time. Later we realised this is the first ever kidney transplant done after covid pneumonia (there are two reported transplants in Covid recovered but none had pneumonia)
With the confidence gained another live transplant was done for a patient 5 weeks after he recovered from covid. Since then, with the confidence gained, our team went on to perform 8 more renal transplants safely.
What was the most challenging transplant?
Out of these, challenging ones were
- blood group mismatch transplant (Abo incompatible) and re- transplant. Both are highly complicated and technically challenging ones
But carrying out a transplant in a covid pneumonia recovered patient was the most difficult one
Did you have any other interesting challenges in the rest of the transplants?
We always prefer laparoscopy ( key hole) for donor operations as the blood loss is very minimal and recovery is faster.2 of these patients had previous open operations and big scars in the abdomen . normally these patients are advised to have open operation.They underwent successful laparoscopic (key hole) operations
One kidney from a cadaver donor had a small stone in the ureter ( tube draining urine from kidney) – this was broken and cleared by our surgeon using ureteroscope and laser before implanting to the recipient
One cadaver kidney had a hemorragic cyst which was completely cleared before the kidney was implanted.
One Patient had severe heart condition , couldn’t cope with dialysis – had fluid accumulations more often making him high risk and transplant was life saving for him
What's the future of kidney transplant with covid spreading further ?
Covid is expected to continue for months / year or so from now with no definite cure or effective vaccine in sight. We believe those who deserve should not be denied a transplant. Not giving a kidney might be more harmful. Kidney diseases could be more dangerous than Covid itself. We personally feel the risk of getting Covid is still high for dialysis patient as they spend more time in hospitals and meet more carriers. There is no evidence that transplants make patients sicker if they get Covid.
Transplants can be safely done with taking safety measures and the patients following precautions such as regular hand washing, social distancing and wearing masks in public places are meticulously followed