Successful Living Donor Kidney Transplantation for Dialysis-Dependent Chronic Kidney Disease

Chief Complaints

A 46-year-old male patient with a body mass index (BMI) of 17 had presented to the Kidney Transplant Department at PACE Hospitals, Hitech City, Hyderabad, with a complaint of a significantly reduced urine output (oliguria) of less than 400 ml per day, severely impacting his quality of life.

The patient had a known history of advanced chronic kidney disease (CKD), likely secondary to chronic glomerulonephritis. He had been dependent on maintenance haemodialysis for approximately ten months, with vascular access provided via a left upper-limb arteriovenous fistula. Additionally, he presented with secondary anaemia, a common complication of advanced renal failure.

On examination, the patient was conscious, coherent, and oriented. He was hemodynamically stable, with mild pallor suggestive of anaemia. A functioning arteriovenous fistula was present in the left upper limb for haemodialysis access. Abdominal examination was soft and non-tender, with no clinically significant swelling or organ enlargement. The remaining systemic examination was normal.

Upon admission to PACE Hospitals, following the clinical assessment, the Kidney Transplant Team conducted a comprehensive evaluation based on the patient’s markedly reduced urine output and dependence on maintenance haemodialysis for approximately ten months. 

A detailed medical history, physical examination, and pre-transplant assessment were performed to determine the severity of kidney dysfunction, identify associated complications, and evaluate the patient’s suitability for kidney transplantation.

Baseline investigations, including complete blood picture, kidney function tests, liver function tests, serum electrolytes, blood glucose levels, coagulation profile, viral screening, blood grouping and cross-matching, and other routine pre-transplant laboratory investigations, were carried out as part of the transplant workup. The investigations showed advanced kidney dysfunction with mild anaemia and elevated liver transaminase levels, which required continued clinical monitoring.

Imaging and diagnostic studies, including abdominal ultrasonography and other necessary pre-transplant assessments, were performed to evaluate the native kidneys, abdominal organs, vascular anatomy, and overall medical fitness. 

Based on the clinical history, dialysis dependence, reduced urine output, laboratory findings, and imaging evaluation, the patient was diagnosed with advanced chronic kidney disease secondary to suspected chronic glomerulonephritis. The exact underlying native kidney disease could not be conclusively established.

Based on the confirmed diagnosis, the patient was advised to undergo End-Stage Kidney Disease Treatment in Hyderabad, India under the care of the Kidney Transplant Team, with the objective of restoring kidney function, eliminating dependence on maintenance haemodialysis, preventing further complications, and improving long-term survival and quality of life.

After a thorough evaluation by Dr. A Kishore Kumar (Consultant Nephrologist and Kidney Transplant Physician), along with Kidney Transplant Surgeons Dr. Vishwambhar Nath (Senior Consultant Urologist & Renal Transplant Surgeon), Dr. Abhik Debnath (Consultant Urologist & Renal Transplant Surgeon), and Dr. K Ravichandra (Consultant Laparoscopic Urologist), a comprehensive assessment was carried out to determine the most appropriate management plan for the patient diagnosed with dialysis-dependent chronic kidney disease secondary to suspected chronic glomerulonephritis.

Based on the clinical findings of advanced chronic kidney disease, markedly reduced urine output, dependence on maintenance haemodialysis for approximately ten months, mild anaemia, and irreversible loss of kidney function, it was determined that Living Donor Kidney Transplantation was considered the most appropriate definitive renal replacement treatment.

This decision was made after careful evaluation of the patient’s overall medical condition, transplant fitness, blood group compatibility, associated risks, and the expected benefits of restoring kidney function and reducing dependence on dialysis. The patient’s wife voluntarily came forward as a living donor and was found suitable to donate her right kidney after completing the required medical, surgical, immunological, legal, and ethical evaluations.

The patient, donor, and his family members were counselled regarding the diagnosis, need for kidney transplantation, associated risks and benefits, donor surgery, possible complications, graft rejection, lifelong immunosuppressive therapy, infection prevention, medication adherence, and the importance of regular postoperative monitoring and follow-up.

Following the decision, the patient was scheduled to undergo Living Donor Kidney Transplantation in Hyderabad at PACE Hospitals under the expert care of the kidney transplant team.

The procedure involved the following steps:

• Preoperative Preparation: After completing donor and recipient evaluations, blood group compatibility testing, immunological assessment, and the required medical, legal, and ethical clearances, the patient was scheduled for living donor kidney transplantation. The recipient and donor were prepared under strict aseptic precautions, and anaesthesia was administered with continuous monitoring of vital parameters.

• Donor Kidney Retrieval: The patient’s wife donated her right kidney. The donor kidney was carefully retrieved while preserving the renal artery, renal vein, and ureter. It was then flushed with a cold preservation solution and prepared for implantation into the recipient.

• Graft Placement and Vascular Anastomosis: An incision was made in the recipient’s right lower abdomen, and the donor kidney was placed in the right iliac fossa. The donor renal vein and renal artery were connected to the recipient’s external iliac vein and external iliac artery through end-to-side anastomoses.

• Restoration of Blood Flow and Urinary Reconstruction: After completing the vascular connections, blood flow was restored to the transplanted kidney. Graft perfusion improved gradually, and urine production began. The donor ureter was connected to the urinary bladder, and a ureteric stent was placed to support healing and maintain proper urine drainage.

• Final Assessment and Closure: The surgical team confirmed adequate graft perfusion, vascular patency, urine output, urinary drainage, and hemostasis. The surgical site was then closed in layers, and the patient was shifted to the intensive care unit for close postoperative monitoring. The procedure was completed without any reported intraoperative complications.
  

Following surgery, the patient was shifted to the intensive care unit for close monitoring of graft function, urine output, blood pressure, fluid balance, kidney function, liver enzymes, and signs of infection or rejection. Supportive treatment was provided for rejection prevention, infection control, pain relief, gastric protection, nausea control, hydration, and nutritional support. 

The patient was extubated on the fifth postoperative day after clinical stabilization, and kidney function showed significant improvement. Regular investigations were continued, while the patient and family were counselled regarding medication adherence, infection precautions, graft care, and regular follow-up.

Upon discharge, the patient was prescribed medications to prevent rejection of the transplanted kidney, reduce the risk of infection, protect the stomach, control pain and fever when required, manage nausea, support nutrition, and maintain overall recovery. He was advised to take all medicines exactly as prescribed and not to stop or change any dose without consulting the kidney transplant team.

The patient was advised to take all prescribed medicines regularly, maintain adequate hydration as recommended, follow dietary and infection-prevention precautions, and keep the surgical wound clean and dry. He was instructed to monitor urine output, blood pressure, body weight, and temperature, avoid strenuous activity, and attend all scheduled follow-up visits and blood tests.

The patient was informed to contact the emergency ward at PACE Hospitals in case of development of symptoms such as fever, reduced urine output, swelling, abdominal pain, vomiting, breathing difficulty, pain over the transplanted kidney, unusual weakness, or any redness, bleeding, or discharge from the surgical wound.

The patient was advised to return for a follow-up visit with the Kidney Transplant Surgeons in Hyderabad at PACE Hospitals as scheduled.

This case highlights the successful management of dialysis-dependent chronic kidney disease secondary to suspected chronic glomerulonephritis through Living Donor Kidney Transplantation. The patient received a compatible kidney from his wife, resulting in improved urine output and kidney function. He recovered well and was discharged in a stable condition with advice for regular follow-up and strict medication adherence.

Frequently Asked Questions (FAQs)