The patient is Mr. N.V.M (57 years old, from Ca Mau), who had undergone two previous kidney transplants. The first transplant was about 10 years ago in the right iliac fossa but was unsuccessful due to transplant rejet, forcing surgery to remove the transplanted kidney. After that, he continued to receive a second kidney transplant in the left iliac fossa. However, 2 years ago, the transplanted kidney continued to decline in function, causing him to return to periodic hemodialysis.
As the main breadwinner in the family, having to depend on dialysis makes his life difficult. Witnessing her husband fighting illness for many years, his wife decided to donate a kidney to help her husband have the opportunity to have a kidney transplant again.
After examination and evaluation at the Center for Nephrology - Andrology, People's Hospital 115, doctors determined that the wife was eligible for kidney donation. However, this is a particularly difficult case because the patient has had kidney transplants twice, with a very high risk of transplant remission.
In addition, the patient also has a history of abdominal trauma surgery with long surgical scars, along with two old surgical scars after previous kidney transplants. CT scan results showed that the aortic and pelvic arteries were atherosclerosis, severe calcification, making it difficult to choose the location to suture the blood vessels of the transplanted kidney.
Faced with these challenges, hospital experts have organized many consultations to develop optimal treatment plans. Before surgery, patients underwent multiple plasma replacements to reduce the risk of transplant remission and used strong immunosuppressants.
During the surgery, the surgical team removed the wife's left kidney by endoscopy and grafted it into the husband's right iliac fossa. Due to many previous surgeries, the adhered area was complex and encountered many difficulties. In addition, doctors had to choose the least atherosclerotic location on the iliac artery to perform the stitching, and at the same time prepare a plan to use artificial blood vessels if necessary.
Assoc. Prof. Dr. Truong Hoang Minh - Head of the Center for Nephrology - Andrology, People's Hospital 115, said that the surgery was successful after many hours of stressful surgery. Immediately after opening the vascular clamp, the transplanted kidney worked well and urine appeared immediately. Only one day after surgery, the patient's kidney function improved significantly, the patient was awake, ate normally and recovered smoothly.
According to experts, kidney transplantation is still the most effective treatment method for patients with end-stage chronic kidney failure, helping to improve the quality of life and prolong life compared to hemodialysis. However, the source of donated kidneys is still limited, while the demand for kidney transplantation in Vietnam is increasing.
The successful implementation of the 3rd kidney transplant for patients with blood vessel abnormalities not only opens up life opportunities for patients but also shows the progress of the organ transplantation field in Vietnam. This success affirms the capacity of doctors in handling complex kidney transplants, requiring close coordination between surgery, immunology and post-transplant resuscitation.
