Apollo Hospitals in Chennai attained an applaudable feat by performing a very interesting operation on January 25. What makes the case interesting is that, 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. 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.
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 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, “There are a substantial number of patients waiting for this kind of 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.”
Doctors call this an unusual feat. “This is an usual feat that has been done there. Even with us, in Global, we have a patient waiting for pancreas and kidney since the past 8 months. The requirement to get a pancreas is a little more stringent than a kidney or liver. So far, we haven’t been able to get such a match. That is why, it hasn’t been done,” saidDr Ravi Mohanka, Liver Transplant Surgeon at Global Hospital and visiting Liver Transplant Surgeon at KEM, Mumbai.
“What makes this case an unusual one is that one donor was a cadaver donor and one was a live donor,” added Dr Mohanka.
Dr Vaidya, “The kidney from the same donor was allocated to our hospital but to a different patient (kidney alone), thus, highlighting the failure in the system to identify our patient that required a dual organ. 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.”
Some interesting facts to know about SPK:
- Apollo started their SPK program in 2015 and are, by far the busiest transplant centre for this type of operation in India.
- 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 per cent 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.
- A pancreas transplant is a surgical procedure to place a healthy pancreas from a deceased donor into a person whose pancreas no longer functions properly.
- Almost all pancreas transplants are done to treat type 1 diabetes.
- Pancreas is an organ that lies behind the lower part of your stomach.
- A transplant of the pancreas is usually reserved for those with serious complications. Pancreas transplants are most often done when a patient also receives a new kidney.
- The pancreas transplant adds little further risk in this situation and offers big benefits. However, transplant surgery is risky. Each person needs to carefully weigh the potential benefits and risks.
Benefits of Pancreas Transplants