First in Israel: Autologous Kidney Transplant

A rare operation took place at Schneider Children's when a youngster's own kidney was transplanted back into his body. Bassam, 16, underwent a liver transplant due to a metabolic disease when he was 5-years-old. A year ago, a tumor was discovered sitting on main blood vessels in his pelvis, which interferred with normal blood supply to the left leg, and also totally blocked the ureter between the left kidney and bladder. As a result, a permanent drainage pipe was inserted into his left kidney for urine removal, but repeated infections resulted in periodic hospitalizations.

Removal of the tumor was an extremely complicated procedure due to its location involving many blood vessels. A multidisciplinary team comprised of oncologists, pathologists, vascular surgeons, urologists and transplant surgeons decided to conduct an unusual and most complex procedure not ever performed in Israel before: extraction of his own left kidney from its natural berth and transplanting it back again in a new place in the right pelvic region, where it could function without interference.

The operation was performed by a team from the Organ Transplantation Department at Schneider Children's led by Dr. Michael Gurevich, Director of the Transplantation and Pediatric Hepatic Surgery Unit at Schneider. Starting with laparoscopy (a minimal invasive technique), surgeons continued with open abdominal surgery that required immense precision to reconnect the blood vessels and ureter. After the left kidney was separated from the tumor, and the blood vessels and ureter detached, it was washed in preservation fluid, and returned to its new location in the pelvis, where transplanted kidneys are usually placed.

There were no complications and the transplanted kidney started to function immediately. The youngster was transferred for initial post-operative care to the Pediatric Intensive Care Unit headed by Dr. Elhanan Nahum, after which he was moved to Pediatrics C headed by Prof. Irit Krause. He was discharged about a week later in good condition. Follow-up care will be supervised by the team in the Nephrology Institute headed by Prof. Daniel Landau. Bassam will continue chemotherapy treatments in the Hemato-Oncology Department headed by Prof. Shai Izraeli.

Dr. Gurevich noted that "transplantation of a patient's own kidney is not common in Israel or around the world, because it requires two operations on the patient, the first to extract the kidney, and then to transplant it back again. All this within a complex anatomical environment, as in this case. I am glad that the transplant was successful. The kidney can now function normally and the youngster no longer requires a drainage tube that caused infections. As the operation was a success, we can begin to investigate possibilities for treatment of the tumor itself through medications."