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First time in Odisha: Kidney Transplantation from a Deceased Pediatric Donor to an Adult as an en-bloc dual kidney transplant

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On 4th March, 2024

A Tale of Hope and Life

In a remarkable tale of medical innovation and human generosity, a 1-year 9-month-old deceased pediatric donor’s kidneys were successfully transplanted en bloc into a 45-year-old woman suffering from end-stage renal disease (ESRD). This complex and delicate procedure, performed on a patient who had been dependent on dialysis for three years, highlights the transformative power of organ donation and the advances in transplant surgery that make such miracles possible.

Dr. Samiran Das Adhikary and his Team.

The Deceased Pediatric Donor: A Tragic Loss and a Legacy of Life

The deceased pediatric donor, a young child of just 1 year and 9 months, was tragically diagnosed with hydrocephalus, a condition characterized by the accumulation of excess cerebrospinal fluid in the brain. Despite undergoing treatment, the child did not recover, leading to a heartbreaking loss for his family. However, amid their grief, the family made the extraordinary decision to donate their child’s organs, a choice that would save and transform the lives of others.

The Recipient: A New Lease on Life

The recipient, a 45-year-old woman who had been battling ESRD for years, had exhausted all other options and was undergoing dialysis thrice weekly. With no suitable living donor available, her hopes for a life free from dialysis were fading.

The En Bloc Transplant: A Surgical Marvel

Due to the significant size difference between the deceased pediatric donor and the adult recipient, the decision was made to transplant the kidneys en bloc. This technique involves transplanting both kidneys along with the aorta and vena cava in a single unit. This approach ensures adequate blood flow and improves the viability of the organs, which are too small to be transplanted individually into an adult body.

The transplant surgery was carefully planned and executed by Dr. Samiran and his Team.

Early signs of success were promising, with the en bloc kidneys beginning to produce urine shortly after transplantation. Over the following weeks and months, the recipient’s health improved significantly, and she began to experience the profound relief of a life free from dialysis.

The Gift of Life: A Shared Legacy

While the kidney transplant marked a new beginning for the recipient, the deceased pediatric donor’s legacy extended beyond this single act of generosity. The child’s liver was also harvested and transported to a specialized transplant center, ILS Delhi, where it was used to perform a life-saving liver transplant.

Conclusion: A Celebration of Medical Progress and Human Kindness

This case exemplifies the incredible advancements in medical science and the enduring power of human kindness. The successful en bloc kidney transplant from a deceased pediatric donor to an adult recipient is a testament to the skill and dedication of the medical professionals involved, as well as the selfless generosity of the donor’s family. Their decision to donate their child’s organs, despite their unimaginable loss, has given others the gift of life and hope.

Milestones

  • 1st Deceased Pediatric Kidney Transplant in Odisha
  • 1st en-bloc Kidney Transplant in Odisha
  • 2nd Deceased Pediatric Kidney Transplant in India

This is a reference to the First Deceased Pediatric Kidney Transplant in India where the donor was 16 months old: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5264203/

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World Kidney Day

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World Kidney Day is celebrated on the second Thursday in the month of March every year.

Kidneys play a crucial role in maintaining our overall health by filtering waste products and excess fluids from the blood. These vital organs are responsible for regulating blood pressure, balancing electrolytes, and producing hormones that help control red blood cell production and bone health.

Unfortunately, kidney disease is a prevalent health concern worldwide. It can be caused by a range of factors, including high blood pressure, diabetes, genetic predisposition, and certain medications. Symptoms of kidney disease may not be apparent until the disease has progressed, making it important to take steps to maintain kidney health throughout life.

To keep your kidneys healthy, it is essential to maintain a healthy lifestyle. Eating a balanced diet, exercising regularly, staying hydrated, and avoiding smoking and excessive alcohol consumption are all important steps you can take. Additionally, managing underlying health conditions, such as high blood pressure and diabetes, can help prevent kidney damage.

If you have a family history of kidney disease or have other risk factors, it’s important to get regular kidney function tests. Early detection and treatment of kidney disease can help slow the progression of the disease and prevent complications.

In summary, taking steps to maintain kidney health is crucial for overall health and well-being. By making lifestyle changes and getting regular check-ups, you can help keep your kidneys functioning properly and reduce your risk of kidney disease.

Facilties

Best Urologist in Bhubaneswar for Erectile Dysfunction

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Dr. Samiran Das Adhikary is the best Urologist in Bhubaneswar for treating Erectile Dysfunction.

Erectile dysfunction (ED), also known as impotence, is a common condition that affects the ability of men to achieve or maintain an erection during sexual activity. It can be caused by a variety of factors, including physical, psychological, and emotional issues.

Physical causes of ED may include underlying medical conditions such as heart disease, diabetes, high blood pressure, obesity, or hormonal imbalances. Lifestyle factors such as smoking, excessive alcohol consumption, and drug use can also contribute to the development of ED.

Psychological factors that can lead to ED include anxiety, stress, depression, relationship issues, and performance anxiety. In some cases, ED may be a side effect of certain medications or treatments.

There are various treatment options available for ED, including medications, psychotherapy, lifestyle changes, and surgery. Medications such as Viagra, Cialis, and Levitra are commonly used to treat ED by increasing blood flow to the penis. Psychotherapy and counseling can help to address psychological and emotional factors that may be contributing to the condition. Lifestyle changes such as quitting smoking, reducing alcohol consumption, and increasing physical activity can also improve ED symptoms.

It is important to talk to a healthcare professional if you are experiencing symptoms of ED. They can help to determine the underlying cause and recommend the most appropriate treatment options for your individual needs.

Facilties

Best Urologist in Bhubaneswar for UTI

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Dr. Samiran Das Adhikary is the best urologist in Bhubaneswar for treating UTIs.

A urinary tract infection (UTI) is a bacterial infection that affects any part of the urinary system, including the kidneys, bladder, ureters, or urethra. It is a common infection, especially in women, and can cause painful and uncomfortable symptoms.

UTIs are usually caused by bacteria entering the urethra and multiplying in the urinary tract. This can occur due to a range of factors, including poor hygiene, sexual activity, urinary catheterization, and conditions that affect the urinary system.

Symptoms of a UTI can include a strong, persistent urge to urinate, pain or burning during urination, cloudy or strong-smelling urine, and pelvic pain. If the infection spreads to the kidneys, additional symptoms may include fever, chills, and lower back pain.

UTIs are typically treated with antibiotics, which can be prescribed by a healthcare professional after a diagnosis is made. Drinking plenty of water and other fluids can also help to flush out the bacteria and reduce symptoms. In some cases, pain relievers may also be recommended to alleviate discomfort.

It is important to seek medical attention if you suspect you have a UTI, as untreated infections can lead to more serious complications, such as kidney damage or sepsis. Preventative measures, such as practicing good hygiene, staying hydrated, and urinating after sexual activity, can also help to reduce the risk of developing UTIs

Facilties

Best Urologist in Bhubaneswar for Kidney Stones

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Dr. Samiran Das Adhikary is the best urologist in Bhubaneswar for treating kidney stones. His philosophy about kidney stones sets him apart from the rest.

Kidney stones are solid deposits that form in the kidneys from minerals and salts in the urine. They can vary in size and shape, from tiny particles to larger stones that can cause severe pain and discomfort.

Kidney stones form when the urine becomes concentrated, allowing minerals and salts to crystallize and stick together. There are several types of kidney stones, including calcium stones, uric acid stones, and cystine stones, each with their own specific causes and risk factors.

Symptoms of kidney stones can include severe pain in the back, side, or lower abdomen, nausea and vomiting, and blood in the urine. Smaller stones may pass through the urinary tract without causing symptoms, but larger stones may require medical intervention to be removed.

Treatment for kidney stones may involve medication to relieve pain and discomfort, as well as measures to help the stones pass, such as drinking plenty of fluids and taking prescription medication to help break up the stones. In some cases, surgery or other medical procedures may be required to remove the stones.

Preventative measures, such as staying hydrated, maintaining a healthy diet, and managing underlying medical conditions that increase the risk of kidney stones, can also help to reduce the likelihood of developing this painful condition.

Facilties

Best Urologist in Bhubaneswar

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Dr. Samiran Das Adhikary is considered to be among the top 3 urologists in the entire eastern zone. He has an experience of over 20 years and is known for his straightforward nature.

HOW TO REACH DR. SAMIRAN?

He did his MCh in Urology from C.M.C. Vellore and thereafter worked as a faculty in the department. During his tenure, he experienced over 1500 renal transplants including several cadavers, and worked apace with stalwarts in the field of urology like Dr. Nitin Kekre and Dr. Ganesh Gopalakrishnan. In 2009, he joined Apollo hospital Bhubaneswar as a senior consultant. At Apollo, he initiated the renal transplant program and has conducted over 300 successful renal transplants since then. 
Recently he started the Cadaveric Renal Transplantation program in the state of Odisha. Making Odisha the 11th state to have done this marvel.

So far he has successfully conducted several cadaveric renal transplants among which, one was performed using a single grapht pediatric (5-year-old brain-dead male ) kidney for 2 adults. At 6 months follow up both the recipients have normal renal function. According to available literature, this is the first of its kind procedure performed in India.
Dr. Samiran has more than 20 publications in several peer-reviewed journals, both National and International. He also does peer reviews for some prestigious journals and has been rewarded as the best reviewer of the year on several occasions.

AWARDS

He has been recognized by various large entities like “The Times of India”, “The Economic Times”, etc.

Professional   qualifications:

Degree                        Institution                             Dates attended                            Year Awarded

MCh (Urology)             Christian Medical College          15th Jan 2003 – 14th Jan 2006                2006

Vellore, India

MS (Gen. Surg)            VSS Medical College, Burla, 1st Sept. 1996- 31st Aug 1999           1999

Sambalpur, India

Internship                     VSS Medical College, Burla,     5th Nov. 1994- 4th Nov. 1995           1995

Sambalpur, India

MBBS (MD)                VSS Medical College, Burla,     2nd Nov. 1989 – 4th Nov. 1994            1994

Sambalpur, India

Work   experience

Senior consultant in urology and renal transplant surgery in Apollo Hospitals, Bhubaneswar, Orissa since Dec 2009 till date
Consultant in Care Hospital. June 2009 to Dec 2009 CARE Hospital, Bhubaneswar
Assoc. Prof.                            June 2008——June 2009       Department of Urology,

CMC Vellore, India.

Asst. Prof.                                April 2006 – June 2008       Department of Urology,

CMC Vellore, India.

Senior Registrar                       Aug 2000 – Jan 2006            Department of Urology,

CMC Vellore, India.

Senior Registrar                        Nov. 1999- Aug 2000          Department Uro-Gyane

Oncology, Rajiv Gandhi    Cancer Institute, Delhi, India.

Resident in Surgery                   Sept. 1996- Aug 1999          Department of Surgery,

VSS Medical College, Burla,                Sambalpur, India.

Junior Resident             April 1996- Aug 1996                       Department of Radiotherapy

IRCH, AIIMS, New Delhi,

Internship                                 Nov1994- Nov. 1995              VSS Medical college,

Burla, Sambalpur, India.

Blog

Repair of large Pseudo aneurysm of left upper arm AVF in a post-renal transplant patient. By Dr Samiran Adhikary. Senior Consultant in the Department of Urology Apollo hospital Bhubaneswar

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This was the acute presentation with a history of pain for 3 days 

This is a 20-year-old girl. She underwent a renal transplant when she was in standard 9 by me at apollo hospital Bhubaneswar. Now she has presented to us with a history of fever and acute pain and increased swelling in her upper arm. At av fistula site. With skin color change. On imaging, it showed. Impending rupture. Which is a life-threatening problem. As it is extremely difficult to control bleeding and a person can lose a lot of blood.

The cephalic vein just proximal to the fistula is normal in caliber for a length of approximately 6 cm with the patent flow.
Large partially thrombosed pseudoaneurysm approximately 6 cm from on the fistula site measuring approximately 5.5 x 4.1 cm. Surrounding soft tissue edema and mild fluid collection is likely suggestive of leaking Pseudoaneurysm.
A short segment of normal caliber cephalic vein team (approximately 3 cm) just proximal to the pseudoaneurysm.
Significant ectasia/ Pseudo aneurysm of the proximal cephalic vein over a length of approximately 11.2 cm with a maximum width of 4.8 cm.

Repaired brachial artery
Excised in Toto 

The brachial artery was Repaired and excised the aneurysm part and unhealthy skin overlying it 

Thanks to my Team at apollo hospital Bhubaneswar. 

Dr Prateek Sahoo. Dr Ram. Mr Ashok and Mr Soumya. 

Dr Mami Parija. Anesthesia 

Dr. Ajit Biswal. Radiologist for providing a very accurate delineation of the pseudo aneurysm

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Circumcision: Conventional / LASER / ZSR which technique. Big confusion ??

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Many techniques has been described. Of late I find my patients are very much confused and always come with good “ In Depth” knowledge after googling for few hours. It has become extremely difficult when a person comes to me with pre formed knowledge of certain things.

I used to get disappointed with these patients and some people even argue and try their point of view to driven in to surgeons mind and some surgeons also started doing as per the patient demand . I have stopped doing these procedures. And request them to see some other surgeons.

But now patients are coming back to me after the surgery done by someone else and their choice surgery with many complications specifically after ZSR ( Stapler ) and LASER technique and that to done by many online promotions of health and medical aggregator. I wish good luck to all my fellow surgeons and also the Uberisation of medical facilities .

Today we had to do one young gentleman who had planned his circumcision well before his marriage he had circumcision by ZSR technique elsewhere and even after two months he has a non healing ulcer in the central part with induration of tissue. He also had some repair under local by primary surgeon. Look like some foreign body inside

We had to excise all the dirty tissue and redo that part.

I have seen many patients also after LASER the issue of non healing. Where as properly done conventional circumcision heal within a weeks time as penile skin is very vascular and healing is very fast.

Healing of procedure completely depends on the vascularity of the cut edge. While the newer techniques are compromised in vascularity. So I apprehend these non healing issues and it’s long term functional outcome.

After the repair.
After excision of the unhealthy tissue.

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1st time in India we used kidney from 5 years old male as deceased donor. ( Brain Dead Donor ) and used as single kidney unit in two adults respectively

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Salute to the brave parents of Master Sudhanshu Lenka who came forward to donate the organ to save two more lives. Master Sudhanshu one 5 years old boy was admitted to KIMS Hospital Bhubaneswar under the care of Pediatric Department for some convulsion related issue and after all attempts it was diagnosed and confirmed that he has become brain dead and nothing could be done to reverse it.

He was declared brain dead on 13/07/2022 evening by the team of doctors from KIMS

Our state organ transplant organization SOTTO was informed and then they alerted all stake holders concerned for the Cadaveric transplant program and co ordinated to the whole process .

Organs were harvested in KIMS and After the harvesting it was taken to SCB medical college. unfortunately no patients were found suitable for renal transplantation. So it was decided by SCB and SOTTO to send it to Apollo Hospital.

Though there was some delay we took the challenge to proceed with the transplantation and successfully did two patients one after another.

As the kidney sizes were good more then 9 Cm we decided to use for two patients as single kidney unit. Both the patients are recovering well. Both the patients were done in Apollo Hospital bhubaneswar Odisha. We did some literature review and found that single kidney transplantation vs paired kidney transplantation and they were found to be successful even in adult patients with good results at 2 years and 5 years and results were comparable So we decided to do 1st case as single unit on right then waited for some time and found to have good urine output. The size of kidney after implantation was good and was having good turgidity. As it looked satisfactory we went ahead with second patient

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4801801/

https://pubmed.ncbi.nlm.nih.gov/9358086/

I thank my team .

Our team consisted of Dr Samiran Adhikary supported by Dr Prateek Sahoo, Dr Ramkumar ,Dr Sunil and Dr Saroj and Anesthetist Dr Saumitra , Dr Debabrata Dash and Dr Samarjit Bisoyi. Dr N K Mohanty Nephrologist.

I also thank Dr Alok Srvastava and Team Apollo In Apollo Hospital Bhubaneswar

I will like to have special mention about Mr Subrat SOTTO co ordinator and Mr Ayush our Transplant Co-Ordinator for their dedication and tireless endeavors

It is the 1st Pediatric deceased donor of the state of Odisha. To my knowledge I am not aware any such donor in India except one in Ahmedabad in 2009.

We are the 1st to attempt to put into adult as single kidney unit and saved two lives successfully

It is first of it kind in India as we have used as single kidney unit.

We have discharged one patient after one week of transplant with creatinine of 1.6 mg % and second one on 11th day creatinine which has reached less then 2 mg %.

After two months.
Bench dissection for the graft