CASE PRESENTATION:
A 55-year old male patient, weighing 50-kgs was posted for a kidney
transplant. He is a businessman by profession and resident of Assam. He
is a known case of Chronic Kidney disease (CKD) Stage 5 for which he was
on hemodialysis (HD) since Jan’21. The reported known comorbidities were
hypertension (HTN), diabetes mellitus (DM), Ischemic heart disease, and
Pulmonary Tuberculosis for which he was taking regular medications.
Preoperative workup revealed a Hb of 11.7; Tlc-10600; Urea-19;
Creatinine-0.8; Calcium-8.6; Phosphorous-4.6; Uric acid- 5.4;
Sodium-136; Potassium-3.4; Chlorides-101; 24-hour urine proteins-124;
Creatinine clearance-5.6; Bleeding time-2 minutes; Clotting Time: 5mins.
Viral parameters were negative and CMV-IgG-1.9; CMV-IgM- 0.25; EBV
IgG-2.2; EBV IgM-0.19. 2D-Echo reported an EF of 60% with good LV/RV
function and Grade-I diastolic dysfunction. A history of blood
transfusion and erythropoietin supplementation was noted.
On 26th January 2022, he received a living-related kidney transplant
from a haploidentical sister, 57-year old, weighing 65 kg. It was an
ABO-compatible transplant. The donated kidney was the right kidney, with
a single donor artery. The arterial anastomosis was through External
Iliac Artery (EIA)-end to side and Venous anastomosis through the
external iliac vein (EIV) from end to side. The Cold Ischemia Time (CIT)
and warm ischemic time (WIT), were 7 and 30 minutes respectively, with a
remarkable state of diuresis. A double-J (DJ) stent and a one-tube drain
were placed. The surgery lasted for 4 hours and required 2 units of
blood transfusion. The patient was given induction with 3 doses of 75mg
anti-thymocyte globulin (ATG). During the surgery, an abscess was
detected in the extraperitoneal layer of the lower abdomen which was
drained and sent for culture and sensitivity analysis.