He lived because his left kidney was taken out and transplanted in a different part of his body

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From the looks of it, 29-year-old Abhay, (name changed) would seem normal. Except that he has to really watch his diet, water intake, keep to a precise exercise regimen and not allow himself the liberty of indulgence. Being normal is luxury to him after a botched-up stone removal surgery damaged his ureter and left kidney. A routine procedure had suddenly turned life-threatening until surgeons at Sir Gangaram Hospital attempted a reconstructive surgery, moving his damaged kidney to the right side and creating a ureter out of his own tissue. At the end of it, they gave him a second lease of life.

Says Dr Vipin Tyagi, Senior Consultant at the Department of Urology and Kidney Transplant, who operated on him after the failed surgery in Punjab. “This patient had a stone in the tube that connects the kidney to the urinary bladder. So, the local surgeon, while removing the stone, accidentally and unfortunately took out the whole ureter. Realising the complication, he referred the patient to us.”

Right now, Abhay is doing well and he will take up to three months to recover. Having undergone massive trauma, he will need a few more months to regain his normal rhythms and become social. “We always feel that the removal of a stone is a minor surgery. But sometimes there are complications like these in which the kidney is at very high risk and you have to do something miraculous to save it,” says Dr Tyagi.

Realising that the left kidney was not connected to the urinary bladder at all, he chose an Auto-kidney Transplant where the kidney was taken out of the left side and shifted to the right as close to the bladder as possible. It was then connected to the blood vessels of the abdomen to the right leg (External Iliac Vessels).

Dr Sudhir Chadha, Co-Chairperson at the Department of Urology, said that they had a choice to either remove the kidney entirely or connect the kidney and bladder again. The third option was to perform the Auto-Kidney transplant.

Elaborating on the rationale for a transplant, Dr Tyagi says, “Abhay is a young person. It’s very hard for younger people to continue with one  kidney. As a transplant surgeon, my responsibility was to save whatever was left of the damaged kidney. I assumed that even if it worked 20 or 30 per cent, a surgery would be worth it.” Explaining the risks of the surgery, he adds, “Abhay’s was a kidney which had already been operated upon. If you make a cut while doing a surgery on a patient’s body, it is a clean cut. But if there is an accident on a patient’s arm or leg, it is not a clean wound. Same with this kidney. It had a torn ureter which made operating on it risky. Second, when we transplant a kidney, it is a major surgery. You do an anastomosis of the artery and veins. So, there is always a chance that the kidney will not work.” An anastomosis is a connection that is made between two tube-like structures in the body. “The left kidney, after being positioned on the right side, had to be connected to the bladder. But there was a gap of 4-5cm. Now we had to bridge this gap. For this we decided to reconstruct a tube of 4-5 cm using the wall and tissues of the urinary bladder. Intestinal tissue cannot be used for ureter reconstruction. As soon as this reconstructed tube was connected to the bladder, the blood flow to this kidney restarted and immediately urine started coming out through this tube,” adds Dr Tyagi.

This Auto Kidney Transplant surgery was not only risky but also very uncommon. According to Dr Tyagi, “In medical science, we usually know the outcome because hundreds of a certain  type of surgery are performed. But with a rare surgery, we cannot predict the outcome with certainty. Fortunately, in this patient, everything went as  per plan.” However, if the kidney continues working well for three months, then it will most likely work lifelong.

Dr Harsha Jauhari, Chairperson of the Department of Kidney Transplant, says that apart from the Auto-Transplant, there are two other types of transplant. When an organ is removed from one person and put inside another, it is an Allo Transplant. When a patient receives an organ from a non-human source, it is called a Xenotransplant.

As for Abhay, who has been discharged after a long time, it is a long way to reclaim the life he used to know. But having made it this far, he is surer now.





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