Surgical Oncology

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 Super Speciality Hospitals, Kaushambi 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.
 

Total Hip Replacement in a Young Adult with Secondary Osteoarthritis of the Hip due to Sequelae of Childhood Septic Arthritis

Early and effective treatment of childhood hip septic arthritis is crucial to prevent or minimize long-term complications such as avascular necrosis, hip dislocation, osteoarthritis, and leg length discrepancy.

We present a case of a 30-year-old male patient suffering from secondary osteoarthritis of the left hip, with complete destruction of the joint over the past 20 years. He had septic arthritis of the left hip at the age of 9, which was only partially treated, resulting in long-term sequelae.

This was a challenging case due to the chronic arthritic hip and associated soft tissue contractures. We performed an uncemented total hip replacement with subtrochanteric osteotomy. The procedure proceeded as planned: the limb length discrepancy was corrected, and the patient was mobilized within 24 hours. He was discharged after four days, pain-free, and walking with support.

He is expected to achieve full weight-bearing and return to all activities of daily living within eight to ten weeks.

A new life donated to daughter-in law by mother in law

A 30-year-old female was diagnosed with chronic kidney disease after presenting with generalised weakness, loss of appetite, and intermittent vomiting. Investigations revealed impaired renal function, and she was started on haemodialysis through a catheter placed in the right side of her neck. She was advised maintenance haemodialysis three times a week.

She consulted our expert team of doctors including Dr Prajit Mazumdar, Dr Inderjit G. Momin, Dr Vaibhav Saxena, and Dr Kuldeep Agarwal at Yashoda Super Speciality Hospitals, Kaushambi. They recommended renal transplantation as the most effective form of renal replacement therapy. Her transplant workup was initiated, with her mother considered as the first donor option.

However, her mother was found to have diabetes, her father had a cardiac condition, and her husband was not a compatible blood group. With limited donor options, her mother-in-law, who had a matching blood group, came forward to donate a kidney and save her daughter-in-law’s life.

After obtaining clearance from cardiology, pulmonology, gynaecology, and psychiatry, along with approval from the authorisation committee, the transplant was successfully carried out with ATG induction. Post-transplant, she maintained good urine output with steadily improving creatinine levels. She was discharged with a creatinine of 1.2 mg/dl. The donor also recovered well and continues to do fine.

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 after developing generalised weakness, facial puffiness, swelling of the legs, nausea, and intermittent vomiting. Investigations revealed severely impaired renal function with urea of 300 mg/dl, creatinine of 15 mg/dl, and haemoglobin of 9 g/dl. He was started on haemodialysis through a catheter placed in the right side of his neck.

He later visited India and consulted our expert team of doctors, including Dr Prajit Mazumdar, Dr Inderjit G. Momin, Dr Vaibhav Saxena, and Dr Kuldeep Agarwal at Yashoda Super Speciality Hospitals, Kaushambi. Renal transplantation was advised as the most effective form of renal replacement therapy. His transplant workup was initiated, and his wife, who had a matching blood group, volunteered to donate.

During the evaluation, he was found to have mitral regurgitation, pulmonary hypertension, and a reduced ejection fraction of 35 percent, which significantly increased his perioperative risk. He was started on medications, optimised with diuretics, and maintained on intensive haemodialysis for decongestion. After cardiology clearance and counselling regarding moderate surgical risk, renal transplantation was planned.

He successfully underwent renal transplantation with Solumedrol and ATG induction. Post-transplant, he maintained good urine output with steadily decreasing creatinine levels and was discharged with a creatinine of 1.2 mg/dl. His pulmonary hypertension and mitral regurgitation also improved, demonstrating the positive impact of renal transplantation on cardiac function.

He continues to do well on outpatient follow-up, one and a half years after transplant, with stable graft function, and is enjoying a healthy life in Myanmar.

A case of ABO incompatible transplant with high ANTI B TITRES

A 37-year-old male was diagnosed with chronic kidney disease three years ago after presenting with frothy urine and hypertension. Initial investigations revealed a serum creatinine of 3 mg/dl. Over the next few years, his kidney function deteriorated, and he was started on maintenance haemodialysis three times a week via an arteriovenous fistula. He was referred to our hospital by a former recipient who had undergone renal transplantation under Dr Prajit Mazumdar. On evaluation by our team of doctors, the need for renal transplantation was explained in view of end-stage renal disease.

His transplant workup was initiated, with his father considered as the first donor. However, he was rejected due to diabetes. Donor evaluation of his mother was then undertaken, but her blood group was incompatible with the recipient. In view of ABO incompatibility, anti-A and anti-B titres were assessed and revealed a high anti-B titre.

After detailed counselling regarding prognosis, risks, and cost, the family opted to proceed with an ABO-incompatible renal transplant. Rituximab was administered two weeks prior to transplantation, and he was started on tacrolimus and mycophenolate mofetil. This was followed by two sessions of Glycosorb column treatment on days 12 and 14, after which his anti-B titre decreased to 1:2. He then underwent renal transplantation with Solumedrol and Simulect induction, with anti-B titres monitored every 12 hours.

Post-transplant, he maintained brisk urine output and his serum creatinine gradually declined. He was discharged with a creatinine of 1.2 mg/dl and continues to do well on follow-up.

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.