Chennai: Apollo Hospitals, Asia’s largest and most trusted multi-specialty chain of hospitals, has achieved two new milestones. Organ transplant team completes Asia’s first combined Bowel and (sentinel) abdominal wall transplant surgery on a young boy who was suffering from Ultra Short Bowel Syndrome and a complicated Kidney transplantation using Hypothermic Oxygenated Machine Perfusion (HOPE). Apollo Hospitals brings the organ preservation device VitaSmart HOPE to India that keeps the Kidney outside the body for a longer period of time with continuous oxygen supply which is better for transplantation.
Seventeen year-old Chinni Krishna was admitted to Apollo Hospitals with muscle wasting and malnourishment, he had lost 20 KGs in two months (from 50 KGs he became 30 KGs). He was previously admitted to a local hospital in Kuppam, his home town in Andhra Pradesh where he was diagnosed with acute mesenteric ischemia a syndrome of sudden loss of blood supply to the small intestine which causes permanent damage to the small intestine. Usually this is treated with angioplasty or open surgery. Chinni Krishna underwent several corrective surgeries at hospitals in his home town which eventually led to the complete removal of the small bowel with Jejunocolic Anastamosis (a surgery where parts of the jejunum and ileum are removed, and the remaining parts are connected to the colon).
Apollo Hospitals initiated nutritional rehabilitation program for the patient to attend to his caloric requirement to stabilize him and to get him ready for a bowel transplant. Over a period of 9 months Chinni Krishna gained 15 Kgs and returned home. He underwent a transplant procedure in February 2020 on availability of Bowel and Abdominal wall from an18 year-old deceased donor.
Team of doctors headed by Prof. Dr. Anil Vaidya-Transplant Surgeon, Apollo Hospitals Chennai, performed Asia’s first Small Bowel transplantation combined with Abdominal Wall Transplant on Chinni Krishna. The patient needed an abdominal wall transplant because of the poor quality of the native abdominal wall muscle and skin due to multiple operations. Furthermore, there is a loss of abdominal space due to contracture of the muscle of the abdominal wall around a smaller volume of bowel.
Speaking about this procedure, Prof. Dr. Anil Vaidya-Transplant Surgeon, Apollo Hospitals said, “An intestinal transplant is a life-saving procedure as it helps patients who have suffered over years without eating solid food and resorting to intravenous feeding. This procedure comes as a blessing for them as it helps them to eat and even taste food again.”
The abdominal wall transplant is a vascularized composite graft with Skin, muscle and subcutaneous fat. The abdominal wall not only helps to cover the underlying transplanted intestine but, the skin serves as an advanced marker of rejection of the intestine. So if the patient is mounting an attack to the intestine, the skin of the abdominal wall will alert the team with the appearance of a rash about 15 days prior to the actual intestine getting affected. This has a huge benefit for the patient because it avoids intestinal dysfunction if the intestine gets affected. The skin thus provides a visual canvas of inherent immunological activity to the patient and the patient can remotely be aware of the quality and functioning of the transplanted organ. This gives the patient control of his own transplanted organs and empowers them.
The same team also performed a complex kidney transplant procedure on a 35 year-old female patient who was on dialysis for end stage renal disease (ESRD). The kidney was also harvested from the same 18 year old brain dead donor and was perfused with Hypothermic Oxygenated Machine Perfusion (HOPE) which preserved the organ for 11 hours. Preserving the organ in this device keeps Kidney Longer and better for Transplantation.
Kidneys harvested from donors are usually perfused and left in a cold environment surrounded by ice / cold solution where the cooling is static. Even though theoretically it can be used for upto 24 hours after harvesting, the quality of the kidney and the outcome decreases as the ischemic (storage) time increases. This HOPE system has the added advantage of continuous inflow of high concentrated oxygen along with the continuous infusion of hypothermic solution. This dual advantage is very important especially in the case of marginal donors as well as in situations where the ischemia time is expected to be long. Studies done in the west have shown that the rejection rate was less in the kidneys perfused with such preservation devices.
The harvested kidney was in cold ischemia for 11 hours and the transplant was done successfully and the patient was discharged with a normal creatinine (ensures proper function of kidney) of on the 4th post-operative day which is remarkable for a deceased donor transplantation. This process also helps in reducing post-operative complication like delayed graft function, dialysis requirements, biopsy and additional hospital stays.
Speaking about two medical marvels performed by the transplant team, Ms. Suneeta Reddy, Managing Director, Apollo Hospitals Group, said, “Apollo Transplant institute is well known for several multi-organ transplant procedures with over 90% success rates. Our organ transplant center is a beacon of quality and hope for patients from across the world. As our commitment towards delivering the best of healthcare service, we have constantly invested in all contemporary medical equipment and technologies yet keeping the services in affordable cost. Now we also brought the best-of-best equipment to support organ preservation to India, the VitaSmart a Hypothermic Oxygenated Machine Perfusion, which is a more advanced machine for kidney, and liver perfusion. This will definitely benefit those patients in getting a better quality of life.”