KNH advances kidney care with successful laparoscopic transplant

36-year-old Dickson Ndekei, a kidney recipient with Dr Patrick Mbugua Head of Renal at Kenyatta National Hospital (KNH). [Edward Kiplimo, Standard]

For the past year, Dickson Ndekei Njoroge, 36, had been experiencing health complications that progressively worsened. While he felt no pain, his body began retaining fluid, resulting in swelling of his hands and legs. Additionally, he developed vision problems that continued to deteriorate. His urine decreased as well, and he sometimes went two days without sleep.

Dickson ignored these symptoms until April 21, 2023, when his failing eyesight finally prompted him to seek medical care.

“I was diagnosed with kidney failure on April 21 2023,” Njoroge says

Doctors diagnosed Dickson with kidney failure, citing the swelling, vision issues, decreased urination, and insomnia as symptomatic.

He was later admitted to the Kenyatta National Hospital where his medical team informed him that he had two options for treatment: dialysis or a kidney transplant.

"The doctors explained that I would need to either start dialysis or get a transplant," Njoroge recalls. "They provided guidance and recommended beginning dialysis as the initial course of action,” he adds.

Njoroge followed his doctors' advice and began receiving regular dialysis treatments. This helped stabilise his condition. However, his physicians continued to discuss the possibility of a kidney transplant as a viable option.

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“I started clinic on September 2023 where I went through a series of tests until August”, he says.

Dickson Ndekei the cousin and also the donor to Njoroge narrates how he decided to help his cousin after seeing him suffer while under dialysis.

“We found out that my cousin had kidney failure sometime last year, after inquiring about hospitals that do transplants, I decided to donate my kidney to my cousin so that could survive like everyone else,” he says.

After that, they were put on tests and finished sometime in December where they were later put on a waiting list for January.

As he waited, Njoroge's doctors discussed advancements in transplant procedures. They explained a new option called laparoscopic surgery, which is less invasive than traditional open nephrectomy operations.

In an open nephrectomy, the surgeon removes the kidney by making a large abdominal incision, sometimes even requiring the removal of a rib. This often involves significant recovery time in the hospital afterwards.

Alternatively, laparoscopic kidney removal uses a camera and tools inserted through tiny abdominal incisions. The kidney can then be extracted with minimal trauma to the body.

“The doctors said the laparoscopic surgery had easier recovery and less risks,” Ndekei noted. “I wouldn’t need an extended hospitalisation,” he added

In January 2024, Ndekei and his cousin Njoroge became Kenyatta National Hospital’s first patients to receive kidney transplants through laparoscopic surgery. The minimally invasive procedure successfully provided both men with healthy new kidneys without complications.

The hospital takes pride in being the first centre in the region to perform transplants through laparoscopic organ removal.

KNH has transplanted at least 250 patients since 2010.

Dr Patrick Mbugua, Head of Renal Clinic at Kenyatta National Hospital explains that laparoscopic surgery helps significantly with pain control.

With minimal incisions, the doctor adds that in laparoscopic kidney removal, there is "less pain afterwards for the patient.

He reported that rather than dealing with discomfort from a sizeable wound, transplant recipients are up and walking within a day or two."

“The successful outcomes for our first two laparoscopic kidney procedures underscore the future possibilities of this technique for transplant candidates,” he says.

He adds that patients recover faster compared to open surgery, which requires a large abdominal incision that takes more time to heal.

At a recent press conference, Dr Mbugua spoke about the decision to utilise laparoscopic surgery for organ transplantation at KNH.

“We aimed to benefit our patients by reducing pain and recovery time,” he explained.

Dr Paul Njogu, a kidney specialist at Kenyatta Hospital, urged Kenyans to feel proud that the country can now perform transplant surgery successfully to match the highest global standards.

He said that the laparoscopic technique minimizes blood loss and pain for patients.

"We don't have a lot of direct pressure on the organ and we can handle it delicately so that we don't damage the organ," Dr Njogu stated.

The doctor reported that successful laparoscopic kidney transplants represent a major milestone in advancing local surgical skill sets.

"We are celebrating that achievement in terms of demonstrating specialised expertise comparable to transplant centres worldwide," he said.

Dr Charles Waihenya, a University of Nairobi lecturer, said that the innovative laparoscopic kidney transplant procedure makes it unnecessary for patients to seek treatment abroad.

"No one needs to leave the country to go for transplant operations in foreign hospitals," he says.

The doctor explained that certain preexisting conditions increase one's risk for kidney failure.

"People who are diabetic and hypertensive are more likely to have kidney failure," he said.

Regarding Njoroge's case, Dr Waihenya stated that his 17-year history with diabetes contributed to his kidney disease.

Additionally, the lecturer said that transplants are more cost-effective long-term than ongoing dialysis.

Njoroge explained that since starting treatment, his national insurance covered Sh450,000 in expenses, depositing Sh300,000 upfront. However, he added that post-transplant medications are the most expensive element, as insurance does not cover them.

Dr Njogu advised that people should get their kidneys checked proactively without waiting for symptoms to appear.

He said a majority of Kenyans have no awareness of existing kidney failure.

"Don't wait for any signs to know if you have kidney disease," he stated.

The doctor also remarked that transplants lead to better health outcomes versus enduring long-term dialysis.

"We always encourage dialysis patients to pursue transplantation instead, because they will be more productive and active," he said.

However, Dr Njogu noted that post-transplant drug costs are still prohibitively high for most patients, despite being cheaper than ongoing dialysis. He expressed hope that future Social Health Insurance Fund (SHIF) policies would cover medications to make transplants economically sustainable over a patient's lifetime.