Kolkata : The Department of Renal Sciences at The Calcutta Medical Research Institute (CMRI), a unit of C.K. Birla Hospitals, has achieved a landmark milestone in nephrology & renal transplants by performing the youngest documented Paediatric Renal Transplant in Eastern India.These complex surgeries were performed on two young children with severe renal diseases and marks a historic achievement for the hospital as well as its commitment to advancing paediatric care and transplantation medicine. The team which performed the surgeries was Led by HOD of Renal Sciences, Dr Pradip Chakrabarti (Transplant Surgeon) and Dr Rajiv Sinha (Paediatric Nephrologist) along with Dr Amlan Chakraborty (Urologist & Donor Surgeon), Dr Satarupa Mukherjee (Paediatric intensivist), Dr Subir Basuthakur (HOD – Anaesthesia) & Dr Subhro Seal (Transplant Associate).
Aadidev, a 6 month old boy of a banker and IT professional, was brought to Dr Rajiv Sinha in an emergency state at a paediatric hospital when he was just 6 months old. He was conservatively treated & later diagnosed with a genetic disorder HLA 1 Beta 2 mutation with autism resulting in an end stage renal disease. At this neonatal age, transplant was the only modality of treatment option available for him. Over a period of 2 years, he was optimised in various multidisciplinary issues to prepare him for the Renal Transplant.
After two years of care, the child was brought to CMRI for paediatric transplant. A multidisciplinary clinical clearance was done & the parents were counselled about the probable risks, complications, technical challenges of undergoing a transplant considering his present comorbidities. Adidev’s mother willingly came forward post counselling and was eager to volunteer as the living donor. In February 2024, Aadidev underwent the renal transplant surgery.
Emphasizing the intricate challenges of paediatric kidney transplant, Dr. Pradip Chakrabarti, HOD – Renal Sciences & Senior Consultant – Transplant Surgeon, Department of Renal Science, CMRI, “The surgical technical challenges of an adult kidney being transplanted in a constrained space of the abdomen, the mismatch size of the vessels of the child compared to the adult kidney, the prolonged anaesthesia during the pre & post operative period to restrict & maintain the normal child state of movements were a few of the major points of concern. As luck would have it, the patient suffered a small gaping of wounds as soon as the patient’s sedation was lowered & he was a little active. We had the entire surgical & anaesthesia team equipped to make a complete surgical repair successfully.”
Dr. Rajiv Sinha, Consultant-Paediatric Nephrologist, Department of Renal Science, CMRI revealed, “The child was under my care for more than two years. The medical team faced a challenging time maintaining hemodynamics, a dynamic electrolyte state & maintaining optimum sedation to keep the child in a stable state for administering all medications. The hassles of prolonged & multiple episode of mechanical ventilation was a chief concern which we could overcome as a team.”
“Handling a special child is always a challenge & more so specially when the mother has also undergone surgical intervention herself. So, it took a collaborative effort on the part of the junior doctors, nursing team and caregivers to come forward and deliver the responsibilities not only with precision but with a sensitive parental touch. The liaison among the various multidisciplinary departments was a key factor behind the success of the surgery. By the twelfth day, he began walking and on the twentieth day, Aadidev left the hospital healthy and was smiling in his mother’s lap. His story is a testament to resilience, meticulous care, and immense love of family,” Dr Sinha added.
Another child, Pabitra Kar, a bubbly and energetic 7-year-old, faced a life-altering diagnosis when she was brought to Dr. Rajiv Sinha with increased urine output and a slightly decreased appetite. The evaluation revealed deranged renal parameters and proteinuria, and genetic studies and a kidney biopsy confirmed Focal Segmental Glomerulo-Nephritis, leading to end-stage renal disease.
Dr. Pradip Chakrabarti said, “In 2023, her family decided to pursue a renal transplant and visited us based on CMRI’s pedigree of conducting the most successful paediatric transplant surgeries in East India. Despite Pabitra’s lean and severe health condition, her grandmother’s determination to donate her kidney, combined with her family’s hope, inspired the medical team to go ahead after which a multidisciplinary clearance was obtained for the same.”
In end February 2024, Pabitra underwent a technically challenging renal transplant. The surgery involved placing the kidney intraperitoneally due to constrained abdominal space and anastomosing the donor’s multiple reconstructed vessels to Pabitra’s common iliac vessels. Post-surgery, managing her hemodynamics with restricted venous access was another challenge. Nevertheless, her urine output was satisfactory, and her renal parameters improved steadily.
“Miraculously, on the seventh-day post-surgery, Pabitra left the hospital smiling and walking with her father- a testament to her resilience, the meticulous care she received, and the unwavering love of her family,” Dr Chakrabarti stated.
Sombrata Roy, Unit Head, CMRI, mentioned, “This remarkable accomplishment portrays our unwavering dedication to clinical excellence and innovation. The entire transplant team has established a new benchmark in paediatric renal care and renal transplant, embodying our ongoing commitment to providing top-tier healthcare facilities to children.”
