Kenya carries sucessful kidney transplant invloving child

“This can only be described as a miracle come true,” eight-year old Anis Yehow Yusuf’s mother Abdia Abdi said in Eldoret after a five-hour successful surgery on the boy to remove an infected native kidney and replace it with a donated one early this month.
The day was January 5, 2022 when a team of 10 resident doctors with the Mediheal Hospital in Eldoret, emerged from the theatre to break the good news to the family, who originally hail from Wajir.
This marked yet another breakthrough in Kenya’s medical history with the successful kidney transplant for the eight-year old, the first ever youngest Kenyan to undergo such a procedure.
“It is a proud moment for Kenya… a historical milestone performing a complex kidney transplant operation on the smallest child ever in Kenya,” Dr. Sanand Bag, a Senior Urologist and Transplant Surgeon with the Mediheal Hospital told People Daily during an interview at the hospital Group’s Parklands branch last Friday.
Dr. Bag revealed that the boy had been suffering for the last two and half years with high blood pressure; headache and seizure, recurrent kidney infections and stone disease, due to which the kidneys were fully damaged.
To India and back in Kenya, there was no solution for Anis’ deteriorating kidney before he was referred to Mediheal Hospital for further screening and treatment.
“Her mother took the child to India, and this was besides the visit to many hospitals in the country for check up and treatment, but nothing could be done,” said Dr. Bag who was accompanied by Dr. Srinivas Murthy, also another senior Nephrologist with the hospital.
Bag said after consultations the child was referred to Mediheal six months ago and parents advised that kidney transplantation was the only solution to save the boy.
“Before we performed the surgery, two years ago, the boy had undergone an operation to remove kidney stones,” Dr. Murthy said.
As if that was not enough, according to a medical report, eight months ago, Anis had had another brain surgery to remove a clot in the brain- an hemorrhage that caused him seizure, and severe headache – in Nairobi.
“It was declared a chronic kidney failure and was put on dialysis since October 2020. But children can’t tolerate dialysis well as it leads to growth retardation in spite of regular dialysis and medications which include heavy drugs such as Iron, Erythropoietin (EPO), Calcium and Vitamin D3 supplements,” Dr. Murthy added. EPO treatment, according to the specialists, dramatically changes the life of a child with end-stage renal disease.
Dialysis, Dr. Murthy explained also affects mental development of a child as they cannot go to school; participate in sports and other recreational activities. “Thus are mentally upset,” he added.
Dr. Bag said Anis received a kidney from his 21 year old cousin.
“However, this was done after thorough evaluation including stone analysis and genetic work up for oxalisis, a stone recurrence which may cause new kidney to fail, donor and recipient work up for transplant and legal formalities, the operation was done on 5th Jan 22,” he said.
The doctors performed a Laparoscopic Operation for the donor which took two hours, and discharged her after three days.
“The recipient operation took 5hours… was managed in a modern renal Intensive Care Unit at the hospital for four days, and was discharged after six days post operation following complete recovery,” he added.
Though successful on the eight-year old, performing such surgeries on small children, the doctors explained that it is usually a tall order which requires a lot of care.
“This is because children’s blood vessels are smaller; tiny, and may not adequately pass blood properly to the adult kidney. The surgery itself is demanding and complex in terms of the small size of the child, the belly where the adult kidney is put is also small,” Dr Bag noted.
 Ehen an adult kidney is put inside the small belly of a child, he pointed out that there is no space to close the abdomen and if done tightly, the pressure inside it will be huge that the kidney will not be fixed properly.
“Joining the blood vessels is technically difficult as the child’s blood pressure is low, and cannot sustain the blood supply to the adult kidney,” he explained.
Renal vessels linked by anastomosis, a connection between blood vessels to main vessels of the body (IVC and Aorta) in children, technically demand surgery thus lead to a lot of bleeding, and hence difficult abdominal closure and compartment syndrome, prolonged blockage and delayed recovery.
“In case of bleeding during the procedure, blood vessels and the kidney will be affected. Alternatively, if the kidneys function properly, there will be a lot of urine produced,” he said.
During analysis, he explained that every step must be done properly to avoid high risk of complications like rejection, delayed kidney function, and vascular thrombosis.
“It is taxing and stressful anaesthesia and perioperative management — ICU care, ventilator, fluid n electrolytes management, different drug doses among others,” he said.
At discharge, the boy’s blood pressure was fully controlled, passing about 2litres of urine daily and kidney function became normal – Creatinine of 0.5 — normal for the age n weight).
The doctors prefer transplant because compared to dialysis, the rehabilitated patient will catch up growth quickly; is energetic- playful, and participates in sports and other recreational activities besides attending to school.
“Then can later on be productive for the country’s economy, culture and other affairs,” Dr. Murthy added.

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