World Kidney Day: After Hypertension Diagnosis, Scientist Now Lives With 5 Kidneys Post Rare Third Kidney Transplant

Imagine living with not one, not two, but five kidneys—two that are failing, two that have been transplanted but are non-functioning, and one that is a new implant sustaining you. This is the incredible reality of 47-year-old researcher Devendra Barlewar, whose relentless battle with chronic kidney disease led a groundbreaking third kidney transplant. After years of dialysis, unsuccessful surgeries, and the crippling effect of COVID-19, his survival is not only about living but a result of the extraordinary progress in modern medicine. Here's how a group of expert doctors in India made history with one of the rarest transplant cases on record.

Mr. Barlewar's story is a testament to the advances of medicine and the strength of the human spirit. Having fought chronic kidney disease (CKD) for more than 15 years, he had his third kidney transplant after two earlier failed attempts. His situation poses a special surgical challenge and immunological risk, an unprecedented accomplishment in organ transplantation.

The battle of the scientist with kidney disease was first encountered in 2008 when he was diagnosed with high blood pressure. Lacking any underlying conditions, his health rapidly worsened, and he became dependent on dialysis by 2009. In the following years, he received two kidney transplants, one in 2010 and the other in 2012, both of which failed, making him depend on dialysis again. The second kidney transplant survived for a number of years before it was sabotaged by COVID-19 in 2022, leading to total organ failure. Lacking close family members for a live donation, he enrolled for a deceased donor transplant at Amrita Hospital in 2023. His turn arrived on January 7, 2025, when a matching kidney from a brain-dead donor was made available.

Challenges of Kidney Transplant

A third renal transplant is very uncommon and has special medical complications, such as:

Immunological Risks: As he had two non-functioning native kidneys and two formerly transplanted kidneys, his immune system was extremely sensitized, which raised the risk of organ rejection. To counteract this, physicians used cutting-edge immunosuppressive techniques to hinder a reaction by the immune system against the newly transplanted organ.

Surgical Complexity: Four kidneys created a space limitation inside the abdominal cavity. The surgeons needed to tread carefully to provide space for the new kidney without compromising its blood supply.

Vascular Limitations: The blood vessels used in his previous transplants had already been utilized, making it crucial to identify and connect the new kidney to the largest available abdominal blood vessels. Extensive preoperative imaging and surgical expertise were required to navigate this challenge.

Dr. Ahmed Kamaal, Senior Urology Consultant, who was a member of the surgical team, added, "This was an unprecedented case. With four existing kidneys, there were huge immunological risks involved and the need for special protocols. We maximized the patient with immunosuppression pre-transplant to preserve his new kidney transplant from the threat of rejection."

Role of the Organ Donor

Organ donation was instrumental in making this operation feasible. The 50-year-old farmer was certified brain dead after suffering a stroke. His family decided to donate his organs out of kindness, and the kidney that was a perfect match for Mr. Barlewar was one of them. Being a long-standing member of the transplant program's registration history, he was prioritized to undergo the procedure.

The operation itself involved careful planning and execution. The surgical team utilized high-tech medical imaging, immunological testing, and microvascular equipment to achieve precision. The four-hour operation entailed:

Preoperative Planning: High-resolution CT scans were employed to establish the most appropriate position of the kidney and check viability of the blood vessels.

Immunological Preparation: Advanced laboratory testing was performed to assess antibody levels, ensuring compatibility and reducing rejection risk.

Surgical Performance: The kidney was attached to the largest blood vessels in the abdomen, with utmost care being taken to prevent any complications.

Postoperative Care: After the transplant, the patient was transferred to intensive care for careful monitoring of vital signs, kidney function, and complications like internal bleeding, infection, or graft rejection.

Dr. Kunal Gandhi, Senior Nephrology Consultant, stressed, "Two non-functioning kidneys pose severe immunological issues, especially during the initial post-operative period. They cause organ rejection if not treated. High-tech medicine and in-house immunology testing were a must to provide the optimal result."

After the successful transplant, Mr. Barlewar's new transplanted kidney started secreting urine within hours, an important sign of graft function. He spent some days in intensive care, where he was continuously monitored to ensure his body received the organ well. After ten days, he was discharged with stable kidney function and his levels of creatinine normalized within two weeks, which was a major improvement in his condition.

Dr. Sameer Bhate, Head of Cardiac Surgery and Senior Consultant, emphasized the importance of the surgical skill involved: "The anastomosis of renal vessels to the largest abdominal blood vessels is a delicate process that calls for skillful surgery."

Although Mr. Barlewar's case is medically unprecedented, it also highlights the significance of organ donation and the evolution of transplantation methods. His experience shows the strength of patients with chronic illnesses and the life-changing effects of novel medical treatments.

Now dialysis-free for the first time in years, Mr. Barlewar is independent once more and back in his routine daily activities. His case provides a precedent within the medical profession, hope for thousands of patients around the globe who are waiting for kidney transplants.

The successful third kidney transplant of Mr. Devendra Barlewar is an affirmation of the latest advances in medicine, unparalleled surgical skill, and organ donor generosity. The tale emphasizes the significance of organ donation in saving lives and the pursuit of medical perfection in addressing complicated medical problems. With ongoing developments in transplantation research, the case is an inspiration to patients and the international medical community as well.

All the doctors who were part of the surgical team are practising doctors at Amrita Hospital in India