The first and second transplant had failed due to uncontrolled hypertension. He was also diagnosed with coronary artery disease and underwent a triple bypass surgery three months ago.

According to Dr S Saravanan, vascular and transplant surgeon, the challenges were four-fold: lack of space for the new kidney, lack of width on the blood vessels to connect the renal artery and vein; the bladder is scarred by earlier surgeries; and the patient has been developing a lot of antibodies from earlier surgeries.

The old kidneys could not be removed because the patient could bleed profusely and require blood transfusion. This could lead to antibody production which could lead to rejection of the new kidney.

“The kidney was placed high above in the abdominal cavity, right next to the intestine as opposed to the conventional approach. The transperitoneal approach (through the gut), a surgery rarely performed even globally, was what saved the patient. This is such an uncommon surgery that I am yet to see a paper published in India on this,” said Dr Saravanan.