In a medical breakthrough that challenges the boundaries of transplant eligibility, doctors at Indraprastha Apollo Hospitals successfully performed a kidney transplant on a 36-year-old man previously deemed ‘too risky’ for the procedure. Also read | Doctor shares how he saved 28-year-old woman from severe pelvic pain by removing 1.2 kg uterine fibroid in rare surgery
The patient, a resident of Gorakhpur, was suffering from a rare genetic blood disorder that had triggered end-stage kidney disease, leaving him dependent on life support and with few clinical options. The journey to the operating table was fraught with complications – Dr Jayant Hota, senior consultant, nephrology, Indraprastha Apollo Hospitals, told HT Lifestyle that the patient’s condition began deteriorating rapidly months before his arrival.
A complex diagnosis
“The patient had developed fever, cough and a progressive decline in urine output nearly two months prior to admission. Investigations revealed significant renal dysfunction and features of thrombotic microangiopathy (TMA), a condition that damages small blood vessels and can lead to kidney failure,” Dr Hota shared.
Despite undergoing multiple sessions of plasma exchange and haemodialysis at another tertiary care centre, the patient’s kidney function failed to improve, Dr Hota added. It was only through advanced testing that the root cause was identified: a severe enzyme deficiency.
Dr Hota explained: “Further detailed evaluation revealed that the patient had severely reduced activity of the enzyme ADAMTS-13, with levels less than 5 percent of normal. Genetic testing… suggested homozygous deletions of the complement factor H-related genes CFHR1 and CFHR3… Kidney biopsy findings also showed significant chronic damage consistent with thrombotic microangiopathy.”
Navigating the ‘too risky’ label
According to the doctor, the combination of ADAMTS-13 deficiency and genetic deletions made the prospect of a transplant a gamble. Many centres hesitate in such cases because the underlying blood disorder often attacks the new organ immediately, Dr Hota added.
He said: “Kidney transplantation in patients with such conditions is generally considered high risk because the disease may recur and damage the transplanted kidney. After carefully assessing the patient’s condition and explaining the risks to the patient and his family, the medical team at Indraprastha Apollo Hospitals decided to proceed with the transplant using a carefully planned treatment strategy.“
To mitigate these risks, the team, led by Dr Hota, departed from standard protocols. “The transplant was performed with several precautions, including avoiding calcineurin inhibitors in the immunosuppressive regimen. The team instead used rabbit anti-thymocyte globulin for induction therapy, along with fresh frozen plasma support to reduce the risk of complications,” he said.
A new lease on life
The patient’s elder brother stepped forward as the donor. Following the meticulously planned surgery, Dr Hota shared that the recovery exceeded expectations – the patient was discharged with normal serum creatinine levels, a primary indicator of a healthy, functioning kidney.
Reflecting on the success, Dr Hota highlighted that this case sets a new precedent for patients with rare genetic markers. “Kidney transplantation in patients with ADAMTS-13 deficiency and associated genetic complement abnormalities is extremely challenging because of the risk of recurrence,” he said.
Dr Hota added: “With detailed pre-transplant diagnosis and careful modification of the immunosuppression protocol, we were able to successfully perform the transplant and achieve a good outcome for the patient.”
He concluded by stressing the importance of precision medicine in modern surgery: “The case represents a rare example of successful kidney transplantation… demonstrating that with careful preparation and specialised management, transplantation can still be a viable treatment option in high-risk patients.”
Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.
