Successful Mother-to-Son Kidney Transplant for End-Stage Kidney Disease

Chief Complaints

A 32-year-old male patient with a Body Mass Index (BMI) of 21 presented to the Kidney Transplant Department at PACE Hospitals, Hitech City, Hyderabad, with end-stage renal disease due to suspected chronic glomerulonephritis. He had been dependent on regular haemodialysis and was referred for further evaluation and Living Donor Kidney Transplantation.

The patient was a known case of chronic kidney disease that had progressed to end-stage renal disease. He had been receiving maintenance haemodialysis for a considerable period because his kidneys were no longer able to adequately filter waste and excess fluid from the blood. He also had mild anaemia, which was considered related to reduced erythropoietin production in advanced kidney disease. 

On general examination, mild pallor was noted, consistent with the patient’s anaemic profile. No icterus or pedal edema was noted. Vital signs, including blood pressure and pulse rate, were assessed as part of the pre-transplant evaluation. Cardiovascular examination revealed normal heart sounds, respiratory examination showed normal vesicular breath sounds, and the abdomen was soft on palpation.

Upon admission to PACE Hospitals, the patient underwent a comprehensive evaluation by the kidney transplant team, including a detailed review of his medical history, physical examination, blood tests, kidney and liver function tests, and abdominal ultrasonography.

The patient was a known case of chronic kidney disease that had progressed to end-stage renal disease and had been dependent on regular haemodialysis. Based on the clinical findings and investigations, the underlying kidney disease was suspected to be chronic glomerulonephritis.

Laboratory evaluation also showed a mildly anaemic profile, which was considered related to reduced erythropoietin production in advanced kidney disease. Elevated liver enzyme levels were noted and monitored as part of the pre-transplant assessment.

Based on the confirmed diagnosis, the patient was advised to undergo End-Stage Renal Disease Treatment in Hyderabad, India, under the care of the Kidney Transplantation team.

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 Department.

The procedure involved the following steps:

• Donor Kidney Retrieval and Preparation: The patient’s mother underwent donor nephrectomy, and her right kidney was retrieved for transplantation. The donated kidney was carefully prepared and preserved before implantation into the recipient.

• Recipient Preparation and Graft Placement: The recipient was placed under general anaesthesia, and the right iliac fossa was prepared for graft placement. The recipient’s iliac blood vessels were carefully exposed and prepared for vascular connection.

• Venous Anastomosis: The donor renal vein was connected to the recipient’s external iliac vein to establish adequate venous drainage from the transplanted kidney.

• Arterial Anastomosis and Initial Reperfusion: The donor renal artery was connected to the recipient’s internal iliac artery. After restoring blood flow, the transplanted kidney turned pink and began producing urine, indicating initial graft perfusion.

• Identification and Removal of Renal Artery Clot: A few minutes after reperfusion, reduced graft firmness was observed. The arterial connection was reopened, and a small clot obstructing blood flow in the renal artery was identified and removed.

• Repeat Arterial Anastomosis and Restoration of Graft Function: The arterial connection was reconstructed, following which the graft regained its pink colour and firmness. Blood flow and urine production were restored, indicating satisfactory reperfusion.

• Graft Doppler Assessment: Intraoperative Doppler showed increased blood-flow velocity at the anastomotic site. This was considered likely related to a difference in the size of the donor and recipient blood vessels. As urine output remained satisfactory, close postoperative Doppler and creatinine monitoring were planned.

• Ureteric Implantation and Closure: The donor ureter was connected to the urinary bladder to allow urine drainage from the transplanted kidney. After confirming adequate graft perfusion, urine output, and hemostasis, the wound was closed in layers, and the patient was shifted for close postoperative monitoring.

Postoperatively, the patient was closely monitored for urine output, serum creatinine, graft blood flow, wound condition, infection, and overall recovery. Regular Doppler assessment showed satisfactory blood flow within the transplanted kidney, with no fluid collection or urinary obstruction.

The patient received medicines to prevent graft rejection and infection, along with gastric protection, pain control, nutritional support, and other supportive care. Urine output improved, serum creatinine decreased, and mild microscopic blood in the urine gradually resolved. The patient was discharged in stable condition with follow-up advice.

Upon discharge, the patient was prescribed medicines to protect the transplanted kidney and prevent rejection, bacterial, viral, and fungal infections. Medicines for gastric protection, pain relief, nutritional support, and blood pressure management were also advised as required.

The patient was advised to take all prescribed medicines regularly, maintain proper wound hygiene, follow the recommended diet and fluid intake, and monitor urine output. He was instructed not to stop or change any anti-rejection medicine without consulting the kidney transplant team and to attend all scheduled follow-up visits.

The patient was advised to contact the emergency ward at PACE Hospitals in case of any emergency or development of symptoms such as fever, reduced urine output, pain or swelling over the transplanted kidney, blood in the urine, vomiting, breathing difficulty, wound redness or discharge, swelling of the legs, or any sudden deterioration in the condition.

The patient was advised to attend follow-up visits with the Kidney Transplant Surgeons in Hyderabad at PACE Hospitals for monitoring serum creatinine, urine output, graft blood flow, urine examination, immunosuppressive medicine levels, and any signs of infection or rejection.

A graft biopsy was to be considered if the creatinine level remained persistently elevated or increased during later follow-up.

This case highlights the successful Living Donor Kidney Transplantation performed for end-stage renal disease secondary to suspected chronic glomerulonephritis. An intraoperative renal artery clot was identified and removed promptly, restoring graft blood flow and urine output. Kidney function improved steadily, with decreased serum creatinine levels, and the patient was discharged in stable condition with medications and regular follow-up advice.