Discharge
“My first life was given by my mother, and the second by the doctor!” Today, Mr. Liu, who was discharged from the hospital after recovery, expressed endless gratitude to the Urology Department of Zhongshan Hospital Affiliated to Fudan University. Mr. Liu has thus become the “highest record” case of blood type antibodies in ABO blood type incompatibility kidney transplantation in China.
Mr. Liu’s medical experience
Mr. Liu, 30 years old this year, was found to have elevated blood creatinine during an examination in May last year (2017). After seeing the nephrology department of Zhongshan Hospital, he was diagnosed with IgA nephropathy and then received dialysis treatment in a local hospital. In order to reduce the pain of hemodialysis and improve the quality of life, he came to the outpatient clinic of Rong Ruiming, chief physician of the Urology Department of Zhongshan Hospital, for help.
After completing the relevant examinations, the doctor decided to perform a kidney transplant for him. Mr. Liu agreed to it, and his two sisters and wife were willing to donate kidneys to him. Since the donors of relatives’ kidney transplants are usually parents, the two sisters and wife of the patient first expressed their willingness to donate, which surprised the doctor. “
“My mother had a kidney transplant in this hospital 10 years ago, and the operation was successful, so I have great trust in Zhongshan Hospital.” The fate of Mr. Liu’s family is tragic, and their trust in Zhongshan Hospital also touched the medical staff.”
11 years ago
In 2007, Mr. Liu’s mother was treated for uremia in Zhongshan Hospital. In order to get a better quality of life, Liu’s father donated a kidney to Liu’s mother. Professor Zhu Tongyu and Chief Physician Rong Ruiming of the Urology Department performed a relative kidney transplant for them, and Liu’s mother recovered well after the operation.
“My mother’s kidney transplant went smoothly in Zhongshan Hospital. My eldest sister and I both wanted to donate a kidney to my mother, but my father loved us and did not allow it. At that time, there were very few cases of husbands donating kidneys to their wives. Their story was reported by the media, and my parents still keep that newspaper.”
Mr. Liu’s second sister still remembers that scene.
After preliminary examination and screening by Chief Physician Rong Ruiming, Mr. Liu’s eldest sister, second sister and wife were all incompatible in blood type. The eldest sister and second sister were type B, his wife was type A, and Mr. Liu was type O. Zhongshan Hospital had already carried out blood type incompatible kidney transplantation in 2016, and the preoperative treatment system was relatively mature, and all cases were successful. Because the eldest sister had kidney stones, she could not be a healthy kidney donor. Therefore, Chief Physician Rong Ruiming conducted blood type antibody tests on his second sister and wife, but was shocked by the results: both of them had very high antibodies, 1:2048 and 1:4096 respectively, and blood type incompatible kidney transplantation requires blood type antibodies to be controlled within 1:16! After full communication between the doctor and the family, Liu’s second sister, who had a relatively low antibody level, was selected as the donor.
Even so, 1:2048 is also the highest record of ABO blood type incompatible kidney transplantation in China!
After the donor was determined, Mr. Liu was hospitalized for blood type incompatible kidney transplantation pretreatment to remove blood type antibodies in the body. A month later, he was hospitalized again for preoperative plasma exchange, waiting for the antibodies to drop to the ideal range, and undergoing a relative’s kidney transplant. Just when everyone was looking forward to the transplant surgery after the plasma exchange, after three plasma exchanges, Mr. Liu suddenly suffered from heart failure, lung infection and atelectasis, his blood oxygen saturation decreased, and he could not lie flat. He was immediately transferred to the surgical intensive care unit of Zhongshan Hospital for treatment. The kidney transplant doctors and critical care doctors worked together. After active treatment, the patient finally turned from critical to safe, his condition was stable, and he was temporarily discharged from the hospital for recuperation, waiting for his body to recover before considering surgery.
During the days of recuperation, every day was a torment for Mr. Liu. After the Lunar New Year in 2018, Mr. Liu and his family urgently found Dr. Rong and prepared to be hospitalized again for kidney transplant surgery. After multiple plasma exchanges in the Department of Nephrology, Blood Transfusion Department and other departments, his blood type antibodies gradually decreased. According to the expectations of the kidney transplant team, the surgery was scheduled for March 12, 2018.
After multiple plasma exchanges in the Department of Nephrology and the Department of Blood Transfusion, his blood type antibodies gradually decreased. According to the expectations of the kidney transplant team, the operation was scheduled for March 12, 2018. However, the blood type antibodies did not decrease after the last plasma exchange, and remained at 1:32. To ensure the safety of the operation, the operation was postponed, and the patient underwent two more plasma exchanges, and the antibodies finally dropped to a reasonable range.
Professor Zhu Tongyu, Vice President of Zhongshan Hospital and Urology Department, led the kidney transplant team, including Chief Physician Rong Ruiming, Chief Physician Xu Ming, and Attending Physician Wang Xuanhua, to conduct a careful evaluation, and after fully communicating with the patient and his family, they finally decided to perform the kidney transplant operation.
On March 19, 2018, Mr. Liu and his second sister entered the operating room at the same time for a relative kidney transplant. The operation was also extremely challenging. Since Mr. Liu had a catheter in the right femoral vein during hemodialysis treatment, Dr. Rong decided not to use the right iliac fossa for conventional kidney transplantation after evaluation, but to choose the left iliac fossa as the surgical site, so that the position of the anastomosis vein would be deeper. Since Liu Erjie had multiple renal arteries on the left side, only the right kidney could be selected, and the vein of the kidney was shorter, so the difficulty of the operation was significantly increased.
It took Dr. Rong Ruiming, Dr. Xu Ming and the kidney transplant team more than 3 hours to successfully complete the kidney transplantation of the siblings. Mr. Liu’s urine volume reached 11,885 ml on the first day after the operation, and his kidney function returned to normal in 2 days.
As a terminal uremia patient who felt the sunshine of family affection, Mr. Liu said that the day he was discharged from the hospital was his new birthday of rebirth. Two generations of a family underwent kidney transplantation in the same hospital, and they have an indissoluble bond with Zhongshan Hospital.
