The Nation (Nairobi)

11 March 2010

Kenya: Kidney Transplant Opens New Frontier for Patients in Continent

Nairobi — The cord of love between two sisters proved unbreakable when one put her life on the line to save the other.

Ms Mary Nginyo, 32, was diagnosed with kidney failure two years ago, which almost proved fatal when she became pregnant at the same time.

But her sister Peninah's love proved far more powerful as the two women underwent the first surgery of its kind in Africa, performed by a team of Spanish and Kenyan doctors at Kenyatta National Hospital (KNH).

Their story signals a bold new direction for Kenyan patients with kidney failure. The introduction of this relatively low-cost transplant technology could reduce the burden on Kenya's scarce dialysis facilities, and help discourage medical travel to other countries where such procedures are more routine.

Mary and Peninah Nginyo were among the first patients to undergo a kidney transplant using new technology known as laparoscopy.

Laparoscopic surgery is a kind of keyhole surgery in which operations in the abdomen are performed through small incisions (usually 0.5–1.5 cm), compared to larger incisions needed in traditional surgical procedures.

Also called minimally invasive surgery (MIS), the procedure uses images displayed on television monitors for magnification of the surgical elements.

The procedure has been applauded in developed countries as it has led to a decrease in pain and scarring and swifter recovery for the patients.
For Peninah, the decision to take part in this historic surgery was quite easy.

"The suffering of a loved one motivated me to donate one of my kidneys," Peninah, who works as a mechanic at Kenya Airways, told the Nation.

The pre-transplant tests were not as easy though, she adds, with the needles and day-long routine tests being the scariest parts.

Peninah and another sister matched as likely donors before she was chosen as the best candidate for the operation performed on Tuesday.
Mary Nginyo was in bed No 8, while her sister lay directly opposite in bed No 17.

For Mary, the first born in a family of five girls, the journey to the operation began at a time when she should have been celebrating life, not staring death in the face. It was during her second pregnancy.

"Initially I was fatigued and my feet were persistently swollen," she said of her early symptoms.

She was diagnosed with renal failure during the fourth month of her pregnancy.

"Last year, in July, I had to begin attending dialysis sessions at least twice a week," Mary said.

According to Dr Anthony Were, the head of the renal unit at KNH, dialysis for expectant mothers is rare though it is done in some cases.

Pregnancy

"At one point we were asked to choose between the life of the mother and the child. But we wanted both alive," said Mr Edwin Maina, Mary's husband.

Seven months into the pregnancy, Mary gave birth to a baby girl whom she named Precious Nkatha. The name symbolised the couple's willingness to risk everything for their baby's survival.

Baby Precious is now a healthy four-month-old.

After delivery, the swelling known as oedema, became worse and Mary was diagnosed with collective tissue disease, or kidney failure.

She was presented with two options to manage the condition: dialysis or a kidney transplant. The latter option is only for patients with end-stage renal disease.

Began journey

In January, doctors urged Mary and her family to consider the transplant option, which gave them a window of one month to think about it. That was just enough time to envision new hope for a healthy life.

"We missed the ever vibrant, industrious Mary. So we settled for the option and began the journey to look for funds to finance the procedure," said Peninah.

Once the transplant option was chosen, the family had only a fortnight to raise Sh550,000 for the operation.

The first kidney transplant in the country was done at KNH in 1978, but it was not until 1988 that the procedure became available on a regular basis. Pre-transplant analysis and the transplant cost about Sh520,000.

For the Nginyo family, the promise offered by the new hi-tech procedure was worth every shilling.

During the interview, as the nurses interrupted to prepare both women for surgery, family members gathered around the pair and whispered a prayer.

"We will both be back healthy," Peninah promised, before being wheeled to the operating theatre where the Spanish and Kenyan doctors had assembled.

The Spanish team was led by Dr Antonio Alcaraz while the local team was led by Dr Mungai Ngugi, a urologist who has practised since 1992.

Dr Alcaraz began the operation as medical students in a separate lecture hall watched via live broadcast, a procedure known as telemedicine.

Less painful

His surgical dexterity was impressive as he meticulously made three incisions on Peninah's abdomen before harvesting the kidney two hours later.

The kidney was placed in a bowl of ice, then Peninah's blood was cleaned away before the organ's arteries were dilated and it was implanted in Mary's abdomen, next to her ailing kidney.

"The three small cuts encourage fast healing, are less painful and are applauded for their aesthetic value," Dr Ngugi told the Nation during the procedure.

With the new technology, the donor spends only a day in hospital. The recipient spends at least five days under observation, and takes immunosuppressant drugs to prevent the body's rejection of the new kidney.

The surgical team hopes this pioneer operation on the continent will encourage more Kenyans to consider seeking the treatment locally.

"We should have faith in our doctors before deciding to head to other countries," Dr Ngugi said after the operation.

Carried out

Nigeria, Mauritius, Sudan and South Africa are some of the countries where transplants are performed routinely, though not using the laparoscopy technology.

Last year, KNH carried out four transplants and it hopes to increase the number to at least 50 by the end of the year.

A normal transplant costs Sh2.5 million in South Africa, and up to Sh1.8 million in India. Private hospitals in Kenya charge an average of Sh1.2 million.

The theme of this year's World Kidney Day is "Protect your kidneys, Control Diabetes".

According to Dr Were, high blood pressure, diabetes and a condition known as chronic glomerular nephritis are the three major causes of kidney diseases.

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