Pune city's Sahyadri Hospital recently conducted an extremely complex and critical simultaneous kidney-pancreas transplantation at Sahyadri Super Specialty Hospital Deccan Gymkhana.

Before this case, four kidney and pancreas transplants were conducted at Sahyadri Super Speciality Hospital Deccan. For the first time in Western India, a single centre has performed five complex simultaneous kidney and pancreas transplant.

Elaborating on this complex case, Dr. Bipin Vibhute, Liver & Multivisceral Transplant Surgeon, said, "Our last case of simultaneous kidney and pancreas was unique and were transplanted to a 52-year-old from Mumbai who was suffering from renal failure since seven years and severe diabetes since 25 years, which had damaged his kidney and even his both lower limbs were weak due to diabetes. He had to depend on dialysis twice a week and heavy doses of insulin. He was completely dependent on his retired father and wife."

Prof. Dr Anil Vaidya, Multivisceral transplant Surgeon, added, "The patient's diabetes complications were not limited to his kidney but his heart was also weak and not good enough or fit for transplantation. When we started his surgery he had lot of fat on his belly and the main blood vessels which carry oxygenated blood from the heart to the abdomen and the lower limbs were completely calcified (calcium deposition in the blood vessels due to diabetes and hypertension) and there was no place on that blood vessel to suture or to give blood supply to the new pancreas and kidney. Hence, for a moment we thought we will not carry out the transplantation for him but after a lot of discussion, we decided to explore more options because this was his best chance and without it he wouldn't have survived for a longer time. Hence, we dissected his lower limbs blood vessels to find out whether we can get sufficient blood supply and fortunately we got 1 cm patch from where we got cadaveric conduit (blood vessel) from which we could give blood supply to both, the new pancreas and kidney, and they were transplanted one above the other otherwise both organs would have been transplanted at different locations. Transplant went well and the patient was discharged from the hospital on the seventh day after transplantation." In addition, what made this transplant a complex one is that the blood supply to the pancreas and kidney had to be derived from a single unconventional source because the conventional vessels were rigid with calcium deposits, making it impossible to use without risking the blood supply to the lower limbs.

Innovative approaches to complex pancreas transplantation should be attempted by a mature team with years of experience. These cases should not be done by a young inexperienced team.

Dr. Dinesh Babu, Senior Anaesthetist, said, "He never required dialysis since transplantation though he was on very small doses of insulin immediately after surgery but now he is off insulin or for that matter any diabetes medicines. We claim this type of surgery not only gives a new life to end stage kidney transplant recipient but also it is amongst world's rare cases. Now, the patient is doing well after the transplant and is completely relieved of his insulin intake and dialysis." Diabetes is one of the most common problems in India and can affect various organs. Replacing kidney and pancreas is one of the most useful solution, however, pancreas transplant is still rare in India. Simultaneous Kidney-Pancreas transplant is an operation to replace kidney and pancreas at the same time in a patient who has kidney failure and also suffers from diabetes, needing very high insulin dose to control sugars.

This surgery eliminates problems by optimally controlling sugar levels and by protecting the transplanted kidney from the adverse effects of diabetes. Additionally, it will also help reverse the effects of diabetes on other systems including peripheral neuropathy thus, protecting the limbs.

Kunal Pandit said, "Those who suffer from heavy diabetes will relate to what I must have gone through. Life was a challenge because of the chronic illness I was suffering and not only me but my entire family was extremely disturbed. Thanks to the doctors and the transplant team, I got a new life which I will cherish. Transplant is no less than a miracle and for me this life without the tensions of taking insulin and dialysis is no less than a dream come true. My goal now will be to spread the noble cause of organ donation, which changes lives of so many patients like me and gives enormous happiness to their families." Dr. Ketan Apte, Head Sahyadri Hospitals Deccan, Nagar Road and Hadapsar, said, "I would like to congratulate the entire team of doctors and staff for their path-breaking work. This success again highlights our mission 'All About Possibilities' where doctors and staff try to push their boundaries to create new possibilities for our patients and bring happiness to their families even in the most difficult situations." The complex transplant surgeries took place under the guidance of doctors including multi-organ transplant surgeons - Dr. Bipin Vibhute, Dr. Anil Vaidya, Dr. Dinesh Zirpe, Dr. Senthil Kumar and Dr. Abhijeet Mane; Transplant Anaesthetists - Dr. Dinesh Babu, Dr. Manish Phatak, Dr. Nivas; Nephrologist - Dr. Sachin Patil; Coordinators - Mr. Arun Ashokan, Mr. Aman and Mr. Rahul Tambe and Medical Social Worker Ms. Sharmila Padhye were also part of this team.