Rare feat as boy, 12, gets new kidney

Doctors have pulled off a rare medical procedure that could be a breakthrough in paediatric kidney transplant.

Surgeons at The Aga Khan University Hospital successfully performed a rare kidney transplant on a boy, 12, in a groundbreaking medical procedure that defied technical odds.

In what can be described as a daring medical move, surgeons gave Fred Ouma from Bondo District the kidney of a 47-year-old adult, the donor just falling short of the 50-year threshold.

In paediatric transplants donors must not be above 50 years because chances the kidney having suffered insults are higher. As a person ages, the nepheron numbers — functioning units of the kidney — go down making them unsuitable.

Willing donors

Medically, it is unethical to remove the kidney of one child to give to another because children are not capable of making informed choices.

Other challenges include identifying suitable and willing adult donors, proliferation of diseases such Hepatitis B, and HIV and Aids, which disqualify many willing donors and cost implications of the procedure.

Until recently, paediatric kidney transplants were rare in Kenya because of lack of local expertise and infrastructure, including lack of modern theatre and surgical equipment.

The technical challenges are more pronounced, especially in cases involving children since their organs have not yet fully developed.

But sitting in his Eastern wing office on the Doctors’ Plaza, overlooking the lush City Park Stadium Bashir Amdani, a consultant paediatrician and paediatric nephrologist, savoured the success of a procedure that could save the country billions of shillings in medical costs as well as millions of lives. "To me it was a learning curve that could potentially open the way for more such operations in local hospitals and a big boost to the healthcare system," says Amdani who led the operation.

"It is an extremely delicate procedure that requires a lot of expertise," he says. For over five hours and in an emotionally charged atmosphere the doctors dramatically pulled one off early last week.

It was a heart-rending session, which saw 47-year-old Ms Jane Ombok, a peasant farmer from Bondo District, put her life on the line to donate one of her kidneys to save the life of her orphaned nephew.

But first she had to go through rigorous tests to determine the compatibility of the kidney, make sure the organs were working and to establish she did not suffer any communicable diseases.

"First you have to identify a donor then check if they have compatible blood groups and a clean bill of health. Next is to see if the donor has two kidneys and that they are working, and if so, where they are located. Not all kidneys are located in the same place. There are abdominal and pelvis kidneys. This procedure saves time and ensures the blood vessels fit properly with those of the recipent," explains Amdani.

Basically, the donor and the patient are set up in two adjacent theatres where the kidney is harvested from the donor and transferred to the patient.

The next major test, doctors say, was to implant the new kidney into the child.

Ideally, says Amdani, the process entails implanting the vessels of the new kidney into recipient vessels and the ureter into the bladder of the patient.

Immediately, if the connection is successful, says Amdani, the blood of the patient flows through the new kidney, forms urine, which goes through the ureter into the bladder and the patient forms urine.

Two-five hours

It is a tedious and delicate process that could take anything between two to five hours. Usually, it involves two surgeons and a perfusionist. A cardiovascular surgeon does the blood vessel connections, urologist implants the ureter and a perfusionist monitors the blood flow through the kidney.

"The child must be monitored closely to ensure the kidney is well perfused — supplied with blood — and given immuno-suppression so that anti-rejection starts immediately?" explains Amdani who performed that role of a perfusionist during the surgery.

Despite the common notion that original kidneys are removed during a transplant, doctors say this is not the case as the implant is inserted as a third kidney.

"Usually you don’t remove the kidneys, but include a third kidney alongside the non-functional ones," Amdani explains.

In the case of Ouma, the new kidney was implanted just above his pelvis bones. The doctors say the procedure was made more difficult because he arrived very sick and had to undergo dialysis first.

"Fred had reached the end-stage kidney failure. Both kidneys had collapsed and we had to put him on dialysis for several days before the surgery," he says.

More obstacles

But much as the doctors passed the first hurdle by successfully implanting the kidney there were many more obstacles to overcome.

There was need to monitor the function of the kidney closely to forestall possible rejection in what is described in medical terms as pre-embossed operating care.

"A transplanted kidney is foreign body tuber and the recipient’s body tends to reject it.

"To forestall this, you give medicine to reduce rejection. The challenge is if you give too much medicine chances of rejection increase," he adds.

In children chances of a rejection are enhanced by poor nutrition. The world over, kidney rejection is 95 per cent likely after five years, the figure reduces to 90 per cent after 10 years and 85 per cent after 15 years, says Dr Amdani.

Fred will have to remain on anti-rejection drugs for life. However the doctors say the amount and frequency of administering the drugs would decrease with time.

According to the surgeon the experience should serve to build confidence among local doctors.