Kolkata/IBNS: The Department of Renal Sciences at the Calcutta Medical Research Institute (CMRI) in Kolkata has achieved a milestone in nephrology and renal transplants by performing the youngest documented Paediatric Renal Transplant in Eastern India.

According to reports, these complex surgeries were performed on two young children with severe renal diseases.

The team which performed the surgeries was Led by HOD of Renal Sciences, Pradip Chakrabarti (Transplant Surgeon) and Rajiv Sinha (Paediatric Nephrologist) along with Amlan Chakraborty (Urologist & Donor Surgeon), Satarupa Mukherjee (Paediatric intensivist), Subir Basuthakur (HOD - Anaesthesia), and Subhro Seal (Transplant Associate).

One of these two young children was brought to Paediatric Nephrologist Rajiv Sinha in an emergency state at a paediatric hospital when the boy was just six months old.

He was conservatively treated and 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 two 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 and the parents were counselled about the probable risks, complications, technical challenges of undergoing a transplant considering his present comorbidities.

The boy’s mother willingly came forward post counselling and was eager to volunteer as the living donor.

In February 2024, he underwent the renal transplant surgery.

Emphasizing the intricate challenges of paediatric kidney transplant, Pradip Chakrabarti, HOD of CMRI's Renal Sciences department, said, "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 and post operative period to restrict and 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 and he was a little active," the doctor said. "We had the entire surgical and anaesthesia team equipped to make a complete surgical repair successfully."

Paediatric Nephrologist Rajiv Sinha said, “The child was under my care for more than two years. The medical team faced a challenging time maintaining hemodynamics, a dynamic electrolyte state and maintaining optimum sedation to keep the child in a stable state for administering all medications."

"The hassles of prolonged and multiple episodes of mechanical ventilation was a chief concern which we could overcome as a team,” he said.

“Handling a special child is always a challenge and 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 doctor added.

"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, he left the hospital healthy and was smiling in his mother's lap,” he said.

According to the CK Birla Group-run health facility, another child is 7-year-old who faced a life-altering diagnosis when she was brought to 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.

Describing the case, Pradip Chakrabarti, HOD of CMRI's Renal Sciences, 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 the girl'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,” he said.

In February 2024, the 7-year-old girl underwent a technically challenging renal transplant, and the surgery involved placing the kidney intraperitoneally due to constrained abdominal space and anastomosing the donor's multiple reconstructed vessels to the patient'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, the hospital said.

“Miraculously, on the seventh-day post-surgery, the girl left the hospital smiling and walking with her father,” Chakrabarti added.

Commenting on the successful surgeries, CMRI's Unit Head Sombrata Roy said, "The entire transplant team has established a new benchmark in paediatric renal care and renal transplant."