Since the surgery was organized at short notice and collecting blood would take time, doctors at Manipal Hospitals came forward to donate blood in order to ensure seamless surgery without any hurdles and hence Dr Ravi Jangamani, Dr Vishwanath and Dr Saurabh Kishte came together for this noble cause. Nephrologist Dr Ravi Jangamani along with a multi-disciplinary team consisting of Urologists Dr Deepak Dubey, Dr. Shivashankar R and Dr. Somanna, CTVS surgeon Dr. Devananda NS and team along with anaesthesiologist Dr. Navneetan were involved in this complex kidney transplantation.
The patient, a resident of Kolkata was suffering from a familial kidney disease called Autosomal Dominant Polycystic Kidney Disease (ADPKD), leading to kidney failure. His condition worsened during the lockdown. He had huge kidneys due to ADPKD and there was no space for the kidney transplantation.
“This was one of the most technically challenging kidney transplants one can imagine. Coupled with this challenge, was the anxiety related to the Covid 19 infection around us. The patient had diseased blood vessels and the only option was to use a synthetic graft. The technique used, was one of the firsts of its kind in scientific literature. The operation and post-operative management was possible due to a determined and tireless effort between multiple teams of doctors”, says Dr Deepak Dubey, HOD & Consultant – Urology, Robotic Surgery and Renal Transplantation, Manipal Hospitals Old Airport Road.
He also had bad blood vessels with 90% narrowing of lower Aorta leading to poor blood supply in the lower part of the body making it difficult for kidney transplantation. With all these, his condition was deteriorating with severe anemia and poorly functioning heart, needing four times week dialysis. This caused a huge financial burden on the patient as well during the lockdown period.
Dr Devananda N S, HOD & Consultant - Cardiothoracic Vascular Surgery, Heart and Lung Transplant Surgery said, “This patient had unique challenges. He had low blood flow to both his legs and at the same time needed a kidney transplant. Doing one without the other would have made treatment incomplete. With our innovation and team work, we could give him the best treatment he deserved. Quality medical care is all about this”.
Dr. H. Sudarshan Ballal, Chairman Manipal Hospitals said, “This was a challenging task indeed as on one side we have doctors battling the corona crisis and on the other side, we have doctors who have displayed compassion, kindness and humanity as the doctors went beyond their call of duty to save the patient. This noble gesture by the team of doctors is especially commendable considering the pandemic, we are really proud of our doctors for their humble gesture. The kidney transplant was an extremely complex surgery and therefore was performed in two stage, in the first stage, his huge polycystic Kidneys were removed to create space for the transplant kidney. In the second stage, his bad blood vessels were corrected and kidney transplantation was done simultaneously”
Dr Ravi Jangamani, Consultant Nephrologist at the Manipal Hospital Old Airport Road said, “This is an extremely critical condition. The only solution left was removal affected kidneys to make space and correct the blood vessels and then perform the Kidney transplantation. However, the surgery was complex and risky. We are on a nationwide lockdown battling a contagious coronavirus pandemic and hence needed to go beyond our capabilities to help and treat the patient. Along with medical challenges due to the complex nature of the disease, we also were facing logistic challenges. The lockdown leads to a shortage of blood donors and unavailability of blood in blood banks. Even though the patient’s blood group was O+, a common blood group, it was difficult to source it and perform this complex surgery.
He further added, we used the state of art synthetic graft (blood channel) to bypass the damaged aorta and restored the blood supply to lower part of the body. We used the same technique to establish a successful blood supply to the transplant kidney also. In this covid pandemic, all the precautions were taken to prevent the infection in the pre- operative, intra-operative and post-operative care by maintaining a covid free corridor. The surgery was performed successfully and was the first of its kind kidney transplantation done at Manipal Hospitals and currently the patient is stable.
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