A challenging Case of renal transplant with a history of >22 units of blood transfusion and class 1 DSA positive


A 26-year-old male was diagnosed with chronic kidney disease after developing generalised weakness and loss of appetite. Investigations revealed impaired renal function with a creatinine of 12 mg/dl and haemoglobin of 5 g/dl. He was started on haemodialysis through a catheter placed in the right side of his neck and advised AV fistula creation with maintenance haemodialysis three times a week.

Despite regular dialysis, his anaemia persisted and he required multiple blood transfusions (more than 22 units over three months) even while receiving erythropoietin and iron therapy. Anaemia workup revealed occult blood in the stool, and upper GI endoscopy confirmed peptic ulcer disease.

He consulted our team of nephrologists (Dr Prajit Mazumdar and Dr Inderjit G. Momin) and urologists (Dr Vaibhav Saxena and Dr Kuldeep Agarwal) at Yashoda Superspeciality Hospitals, Kaushambi, where renal transplantation was advised. His mother, who had a matching blood group, was identified as the donor. However, transplant workup revealed donor-specific antibodies on single antigen bead testing (Class I) with an MFI greater than 2500 on multiple beads, most likely due to the multiple blood transfusions. This significantly increased the risk of acute rejection in the immediate post-transplant period, making the case high-risk.

After thorough counselling regarding risks, he underwent desensitisation with two sessions of plasmapheresis and IVIg to reduce the donor-specific antibodies. He then successfully underwent renal transplantation with ATG induction. Post-transplant, he maintained good urine output with steadily improving creatinine levels and was discharged with a creatinine of 1.2 mg/dl.

He continues to do well on outpatient follow-up.

Treatment By:
Dr Prajit Mazumdar, Dr Inderjit G. Momin, Dr Vaibhav Saxena, and Dr Kuldeep Agarwal

An International patient from Myanmar with Mitral Regurgitation, pulmonary hypertension and low ejection fraction-35% underwent successful transplant


A middle aged male was diagnosed with chronic kidney disease when he developed generalized body weakness, puffiness of face and swelling of legs with nausea, intermittent vomiting . On Investigations, he was found to have deranged renal function with urea-300 mg/dl,creatinine of 15 mg/dl, hb-9 mg and was subsequently started on hemodialysis via catheter inserted in right side of neck. 

He subsequently visited India where he consulted our expert team of doctors-Dr Prajit Mazumdar, Dr Inderjit G Momin,Dr Vaibhav Saxena and Dr Kuldeep Agarwal at Yashoda superspeciality Hospital, Kausambi who advised her to under renal transplant as it is the best form of renal replacement therapy. His Transplant workup was subsequently started and donor was wife and blood group was same.

However on transplant work up, it was found that he had Mitral Regurgitation, pulmonary hypertension and low ejection fraction-35% which increased his peri operative risk. Subsequently he was started on medicines and decongestion was done with diuretics and intensive hemodialysis. Subsequently renal transplantation was done after obtaining cardiology clearance with moderate risk and explaining the risk.

He underwent renal transplantation with Solumedrol and ATG induction. After transplantation he had good urine output with decreasing creatinine and was subsequently discharged with creatinine of 1.2 mg/dl . After transplant his pulmonary hypertension decreased and mitral regurgitation decreased which proves renal replacement therapy in form of transplant leads to improvement of cardiac condition.   He is doing well on OPD  follow up even today, 1.5 year after transplant with stable graft function and enjoying his life in myanmar.
 

Treatment By:
Dr Prajit Mazumdar, Dr Inderjit G. Momin, Dr Vaibhav Saxena, and Dr Kuldeep Agarwal

A challenging case of Erythroderma in a young male patient.

A 31-year-old male presented to our dermatology OPD with severe redness and flakiness of skin all over the body. The symptoms had been present for two months, with a marked worsening in the last 15 days. After a detailed history, examination, and workup, the patient was diagnosed with Erythroderma – a serious condition where there is erythema and scaling over more than 90% of the body surface area. Despite having experienced similar skin problems in the past, the patient had never received a correct diagnosis and was unaware of the underlying disorder that could have led to Erythroderma.

Given the extensive nature of skin involvement and risk of serious complications, he was admitted for detailed evaluation and prompt management. A thorough workup was performed, and appropriate medical treatment was initiated. Over the course of 7–10 days, the patient showed remarkable clinical improvement; the skin lesions resolved significantly, systemic parameters stabilized, and he was safely discharged.

Most importantly, after nearly 3–4 years of recurrent but undiagnosed skin issues, the patient was finally diagnosed with atopic dermatitis. This accurate diagnosis not only explained his longstanding symptoms but also enabled the initiation of targeted treatment and counseling regarding long-term care and preventive measures. With this approach, the patient was able to move beyond temporary symptom relief toward effective disease control and an improved quality of life.

Treatment By:
Dr. Kriti Maheshwari

A 4-year-old male child with congenital Pelvi-Ureteric Junction (PUJ) Obstruction underwent Robot-Assisted Pyeloplasty at Yashoda Medicity. The child had an excellent postoperative recovery and was discharged on postoperative day 2.

Robotic surgery offers superior precision and control, providing a significant advantage not only in cancer surgeries but also in pediatric minimally invasive procedures.

The benefits of robotic surgery over conventional techniques include smaller incisions, minimal intraoperative blood loss, enhanced surgical precision and dissection, reduced postoperative pain, and faster recovery and discharge.

The Department of Urology at Yashoda Medicity is committed to providing the highest standard of care to every patient, with special expertise in Robotic Surgery, Reconstructive Urology, Uro-Oncology, Stone Diseases, and Renal Transplant Surgeries.

Treatment By:
Dr. Vaibhav Saxena

The Department of Urology at Yashoda Medicity, Indirapuram, headed by Dr. Vaibhav Saxena, a pioneer in Robotic Urological Surgeries, has successfully performed a wide range of robotic procedures in both Urology and Uro-Oncology. Patients from across India have been successfully treated for various cancers and other urological conditions.

Among his recent notable cases was a Robotic Radical Cystectomy with Pelvic Lymph Node Dissection and Intracorporeal Urinary Diversion, performed on a patient who had travelled from Mathura for treatment. The patient had previously received neoadjuvant chemoradiation but developed a recurrence in the urinary bladder. Curative robotic surgery was deemed the best option. The patient underwent a successful procedure and was discharged on the fifth postoperative day.

Treatment By:
Dr. Vaibhav Saxena