Lucknow boy with rare vascular anomaly recovers after second kidney transplant

Chennai: A 12-year-old child from Lucknow, born with an unusual vascular condition in which he lacked major abdominal blood vessels, underwent a second kidney transplant at MGM Healthcare. Doctors reopened new pathways to give him the second donor kidney. Nearly two weeks after the surgery, the teen is recovering well, demonstrating early graft function with no complications, doctors said.

The child, Arhan Kalra, who has a V4 venous anomaly, lacked major abdominal veins and associated networks from birth, presenting a significant challenge to life-sustaining procedures, said interventional radiologist Dr Ram Gurajala. The child lacked major veins inferior vena cava, the body's largest vein, and the major iliac veins in the pelvis and their networks within the abdomen, disrupting normal flow and drainage of blood from abdominal organs.

"Earlier, he underwent a kidney transplant, but the graft failed. Another procedure was inevitable," said Dr Senthil Muthuraman, senior consultant in multi-visceral and abdominal organ transplant at the hospital. "For a kidney transplant, the new organ is connected to the existing major veins for proper blood flow. But the absence of these vessels in the patient was an obstacle for surgery," he said.

The surgeons devised a strategy to utilise the venous pathways that developed and were preserved from the child's earlier transplant. "We removed the failed kidney graft while meticulously safeguarding the existing venous structures. This allowed for the safe and effective placement of and blood supply to the new kidney," he added.

On Thursday, consultant paediatric nephrologist Dr Sukanya Govindhan said the child is recovering well with no immediate vascular or urological complications. Managing the patient with dialysis until the second transplant was challenging, the doctor said. "We use a fistula or venous access in the hand for dialysis. In this case, these options were absent. A dialysis catheter was the next option. But the child had no patent veins that could be accessed from the groin or neck," Dr Govindhan said. "A catheter was placed through a trans-lumbar approach (from the lower back) into a vein above the kidney. We used this to put him on dialysis for several months before the renal transplant. We are happy the child has recovered well," he said.