A kidney transplanted to the pancreas to save a 4-year-old boy. At the Città della Salute in Turin they resorted to a technique “never used before”, they explain from the structure, to treat a small patient already transplanted with a liver and in a very critical situation. Today the little one is fine, he has undergone a “kidney transplant connected to the pancreas” and in his future there will now be room for the typical everyday life of a child of his age, previously impossible: he can go to kindergarten, play with peers.
The child, of Moroccan origin, had arrived at the emergency room of the Regina Margherita Infantile Hospital of the City of Health of Turin at 2 months of life for persistent vomiting and had discovered on that occasion terminal renal failure. He hasn’t left the hospital since. The kidneys were completely petrified due to a rare and serious genetic disease, primary hyperoxaluria, which in the most severe forms leads to renal calcification within a few weeks of life.
The treatment of this disease consisted of dialysis for 5 hours every day to prevent the massive deposits of calcium oxalate from destroying the eyes, bones and the whole body, while waiting for a combined liver transplant (which is the congenital defect of the enzyme necessary to purify oxalate from the body) and kidney. Following the patient step by step in the hospital on his path from birth Licia Peruzzi, clinical director of pediatric renal transplantation of the Regina Margherita pediatric nephrology, directed by Bruno Gianoglio.
The liver-kidney transplant took place at 15 months of life, but, despite an intensive purifying treatment and the restoration of enzymatic function, the release into the circulation of large quantities of calcium oxalate from the tissue deposits in which it had accumulated irreparably damaged the transplanted kidney made it necessary to resume daily dialysis, causing great growth and feeding difficulties, which made it impossible for the child to even go to play in the park or see other children.
The clinical situation had progressively complicated due to thrombosis of the iliac veins and vena cava, which are normally used to perform a new kidney transplant, thus making a traditional surgical approach impossible. Through an in-depth vascular study it was highlighted that the only possible way would be to use the spleen vein in its course inside the pancreas in the direction of the liver, a road never traveled before in the world in a patient with a liver transplant.
The study of the feasibility of transplantation was therefore started through a biopsy of the transplanted liver, the measurements of the pressures in the abdominal veins (by interventional radiology), the study of the residual ureter and antibodies due to repeated transfusions which fortunately have shown that it would have been technically possible. At the end of the course, the child was enrolled on the list for pediatric kidney transplantation with urgency criteria, since the vascular access for dialysis, which was linked to his survival in life, was the last possible.
After only 20 days, thanks to the regional transplant coordination, the organ arrived. The intervention lasted about 6 hours, in the field a multidisciplinary team made up of Renato Romagnoli (Director of the liver transplant center at Molinette hospital) and Francesco Tandoi; Aldo Verri (Director of Vascular Surgery at Molinette Hospital) and Claudia Melloni; Simona Gerocarni Nappo (Regina Margherita Pediatric Urology Director) and Massimo Catti, assisted by the anesthetists directed by Roberto Balagna. Everything went according to plan. And the new kidney, attached to the spleen vein inside the pancreas in the direction of the liver, started producing urine already in the operating room, without there being any suffering for the liver transplanted 3 years earlier, they explain from the hospital.
The patient was able to be immediately awakened. After just two days the kidney function was already normalized. The little one was able to resume feeding and playing. And he returns to his world, after 4 years of life lived within the confines of a hospital.