Rare dual-transplant after kidney transplant gives kid a new lease of life

When kids his age were learning to stand or take their first toddler steps, Sanish was undergoing dialysis sessions and battling for survival. At the age of 1, little Sanish was detected with medullary cystic disease of the kidney. It all started with high fever and problem in urinating. The child had to undergo 38 sessions of dialysis before he was eligible for a kidney transplant. At 12 years of age he underwent kidney transplant surgery where his mother donated her kidney. This was in the year 2002.

“After the kidney transplant, the first 2 years went very well with my creatinine levels increasing. However, by 2012 I started vomiting blood again and the doctors told me that I had a problem in my liver too which was affecting the transplanted kidney,” recollected Sanish.

However, the nightmare for the family didn’t end there. Sanish’s health, instead of getting better started deteriorating. He would feel nauseous for 6-7 hours straight and had trouble sleeping at night.

“I went to many doctors all over Bangalore. Many a times I had to undergo endoscopy because of leakage of blood in my internal part of the stomach. By September 2015, my transplanted kidney started failing and I had to be put back on dialysis. The doctors suggested that I go for a second transplant for both kidney and liver,” said Sanish

By 2016, he was recommended to Dr. Sumana Kolar Ramachandra. “When Sanish came to us, he had upper GI bleeding with low platelet and two episodes of Hepatic encephalopathy,” said Dr. Sumana.

“We also conducted a liver biopsy and found out that his liver was badly damaged and he had to undergo a liver transplant. We registered him for a combined liver and kidney transplant,” added the doctor.

“I had finally managed to come to terms with the fact that I had to undergo another kidney transplant, as suggested by all the doctors. However, after meeting Dr. Sumana, I realized I had to undergo a combined liver and kidney transplant. It was a difficult period for me and my family,” said Sanish.

To boost Sanish and his family’s confidence, the doctors at Columbia Asia organized a combined talk with Sanish and his family to educate them about the procedure of kidney and liver transplant. This session helped answer all the questions Sanish and his family had before undergoing such a big surgery on dual transplant.

The life-saving combined liver and kidney transplant was performed on February 1st, by the Columbia-Asia-Medanta Liver Team led by Dr. A S Soin, Chief Hepatobiliary and Liver Transplant Surgeon Chairman, Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity and Dr. Sumana Kolar Ramachandra, Chief of Liver Transplant, Columbia Asia Referral Hospital, Yeshwanthpur

This was made possible by the generosity of the family who donated their loved one’s organs after brain death, thus helping save 5 lives. Many staff members from Columbia Asia Hospital also donated blood and platelets that were required for the transplant surgery.

“The drawback in this case was that he would be more prone for infections as he was already on immunosuppression for so many years. After the surgery for the first few days, Sanish had post-operative infections but medical attention and his will power made him come out of the trauma,” said Dr Sumana.

“Only 2% of all liver transplants are done as combined transplants along with a kidney, and this is possible only at a handful of advanced transplant centers. Sanish’s transplant was complex as he was suffering from both liver and kidney failure, and it took 11 hours for our team of 30 doctors and nurses to complete the surgery. One major challenge in this combined surgery was the deranged clotting in liver disease which could cause bleeding that was made worse by bad platelet function due to kidney failure. However, with meticulous surgical technique, we could perform the combined transplant with only 2 units of blood. Another unique challenge is that for liver transplant we keep the blood pressure on the lower range of normal, while for kidney transplant, the blood pressure is best kept high. The balance between these situations was achieved by good aesthetic and surgical techniques,” said Dr. A S Soin, Padma Shri awardee, surgeon and pioneer in the field of liver transplantation.

Sanish now 26-years-old is doing well and has been discharged from the hospital. He dreams of becoming a stock investor one day and now he can finally pursue his dream. Sanish is one of the many patients in India who can get a new lease of life with liver transplant.

"In the last 40 years, liver transplant has evolved from an experimental procedure to the only definitive treatment option for patients with Acute Liver Failure and End Stage Liver Disease. The only way we can increase the number of liver transplants in our country is by creating awareness among the doctors and the general population and by increasing the organ pool. At present the Liver Transplant Centres are concentrated in the metropolitan cities, there should be more transplant centres across the country so that people have more access to transplant," added Dr A S Soin.

Highlighting the state of patients who require liver transplant in India, Dr Nandakumar Jairam, CEO, Columbia Asia Hospitals, said, "At present, there are around 25000 patients who need liver transplant every year which is approximately 20 per million population. Approximately 1200 to 1500 transplants are being done every year according to statistics of the past 3 years. Most liver transplants being done in India are Living Donor Liver Transplants. The deceased donor transplants are predominantly being performed in Southern India."