Monday, 7 April 2008

Medical Miracle: Repaired kidneys the new hope

April 7, 2008
By Syed Akbar
A group of Japanese doctors has been removing cancerous kidneys from patients, repairing them on the surgical table and then transplanting them in people, whose kidneys have stopped functioning. This is a medical miracle as the diseased kidneys, which otherwise find their way in hospital surgical wastes, have been saving the lives of kidney-failure patients.
And Indian doctors say this Japanese medical practice could be replicated in the country to meet the acute shortage of donor kidneys. India has one of the stringent organ transplantation Rules and cadaver transplantation is still seen as a taboo here. But doctors say it will take some time for Indian health experts to make the Japanese practice an Indian reality.
"Kidney repair is quite possible and 'repaired" kidney can be used for transplant. From oncology perspective, if a cancer kidney is to be used for transplant, the tumour should be small, less than 4 cms. If the cancer size is big, it makes it impossible for transplantation," says Dr Vijay Anand P Reddy, director of Apollo Cancer Hospital.
But there's a warning attached to the repaired kidney transplantation. The tumour may recur in the rest of the kidney.
Dr Shiro Fujita of the Department of Urology, Uwajima Tokushukai Hospital, Ehime, Japan, one of the pioneers of "kidney repair" technology, however allays the fears of the Indian doctors and patients. Says Dr Shiro, "graft survival rate of restored kidney transplantation appears to be comparable to that of deceased kidney transplant when donor age and multiple previous transplants are taken into account. As far as donors/patients and recipients understand the risks and benefits, restored kidneys will be a last resort, a novel source of renal allografts in countries where the deceased donor is scarce".
Dr Shiro and his team obtained between January 1991 and September 2006, 42 kidneys from 38 patients. The lesions were removed and repaired outside (ex vivo), then transplanted.
"One, five and 10-year patient survival rates of restored transplant patients were 92.9 per cent, 79.3 per cent and 63.8 per cent, respectively. The graft survival rates of restored kidney transplant patients were 78.6 per cent, 51.8 per cent and 42.7 per cent, respectively for these years. There were no recurrence of small renal cell carcinomas.
There was one recurrence of ureteral cancer in the transplanted kidney 15 months after operation," Dr Shiro told this correspondent.
Dr Ch Subba Rao, head of the department of urology, King George Hospital, Visakhapatnam, agrees with Dr Shiro. He says repaired kidneys are possible
in certain cases in India too. "It may prove to be helpful in a state of organ shortage, but the disadvantage is the possibility of donor disease recurrence. It is going to bring down the cost of kidney transplantation."
"Because of the grave shortage of deceased kidney allografts in Japan, we have embarked on a new source of organs; restored kidneys from living patients," Dr Shiro said.
Senior urologists like Dr V Raja Gopal, however, feel that the Japanese technology cannot be replicated in India. "It is very difficult to replicate the method in a country like India. It is very risky and is associated with a lot of complications in the kidney transplant recipient.
It will be much more expensive with high risks involved. This kind of work reported from Japan has not been reproduced elsewhere in the world. In a country like India, it is not going to be answer to organ shortage," he argues.
The Japanese technology is not cost effective, points out nephrologist Dr T Ravi Raju. "Since kidney repair and transplantation are done together. Both have advantages and disadvantages. It is not cost effective". The team led by Dr Shiro has opened a sort of debate among Indian doctors on the need to introduce such a system in India where the waiting list for kidney donation is quite high.
"Urologists encounter not only patients in need of renal transplantation, but also patients who need nephrectomies. This is because we came up with the idea of using kidneys destined to be discarded to those in need of renal transplantation. Instead of autotransplantion of kidneys with aneurysms or small renal cell carcinomas after back table repair, we transplanted the kidneys into third party recipients as an innovative practice," Dr Shiro said.

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