While most simultaneous Pancreas-Kidney transplants are performed from organs harvested from the same cadaveric donor, this case highlights the need to adapt to other strategies to help patients when the allocation rules for the kidney do not favour diabetics on dialysis.
Patients with diabetes and renal failure requiring dialysis, receive organs (pancreas and kidney) from the same cadaveric donor and are transplanted simultaneously. Currently, there are a substantial number of patients waiting for this dual transplant which would not only help them come off dialysis but, more importantly, cure their diabetes that was the root cause of the kidney failure.
Mr. Hitesh, a 38-year old patient from New Delhi, was on such a waitlist for a simultaneous Pancreas Kidney transplant (SPK) for over 8 eight months. International data suggests that diabetic patients on dialysis are prone to cardiac complications and have a median survival of 8 years if they do not get a transplant in time. In addition, there is a 8-12% chance of death every year on the waiting list.
The rules of allocation of the kidney in India does not recognise this fact and such patients who need these dual transplants may have to wait along with other patients who are on the list for a kidney transplant alone (due to reasons other than diabetes). Furthermore, a pancreas graft (that can potentially cure diabetes) may not be utilised because the kidneys from the same donor have been allocated to other patients who are not diabetic. Considering the situation, the team of doctors at Apollo Institute of Transplantation, adopted a different strategy in order to shorten the time a patient waits on the list for dual organs.
A simultaneous cadaveric Pancreas and live-donor kidney transplant (SCPLK), a ‘first of its kind’ in Asia was opted to save Hitesh. The pancreas was harvested from a suitable cadaveric donor from Vellore and simultaneously, the kidney was donated by Hitesh’s wife, Ms. Supriya. The kidney from the same cadaver donor from Vellore was allocated to another patient at Apollo.
Elaborating the case, Dr. Anil Vaidya, Multi Visceral Transplant Surgeon at Apollo Hospitals, said “Apollo started their SPK program in 2015 and are by far the busiest transplant centre for this type of operation in India. There are a substantial number of patients waiting for this dual transplant that not only helps them come off dialysis but, more importantly cures their diabetes that was the root cause of the kidney failure. In this case, a suitable pancreas donor became available in Vellore. The kidney from the same donor was allocated to our hospital but to a different patient (kidney alone). We went ahead and activated the live donor kidney option since the pancreas was from a young donor and was deemed suitable for our patient.”
Thus, with perfect coordination, three simultaneous operations were conducted by the team of doctors at Apollo Hospitals to assure that the cold ischemic time for both the organs was not long. This surgical team was led by Dr. Anil Vaidya, Multi Visceral Transplant Surgeon at Apollo Hospitals, Chennai. The pancreas from deceased donor was harvested by Dr Elankumaran and Dr Senthil (both senior consultant transplant surgeons) from Vellore to Chennai with utmost care while, Dr Ananthakrishnan (senior consultant urologist), undertook a kidney donor operation in the middle of the night on the patient’s spouse, Mrs Supriya Sindhwani, through a robotic procedure at Apollo Hospitals.
Dr Dinesh, Senior Consultant Anesthetist, Apollo Hospitals was instrumental in the operative and post-operative process. Mrs Supriya Sindhwani (live donor-kidney) and her husband Mr. Hitesh Sindhwani are both well. Mr. Hitesh Sindhwani is experiencing a life without diabetes and dialysis.
