Single stage laparoscopic splenectomy and renal transplant in a patient of idiopathic thrombocytopenic purpura with end stage renal disease

Jauhari, H.; Chowey, P.K.; Narani, K.K. and Gupta, A.K. (2002) Single stage laparoscopic splenectomy and renal transplant in a patient of idiopathic thrombocytopenic purpura with end stage renal disease. In: The 13th Annual Conference of Indian Society of Organ Transplantation, 26-30 Sept 2002., Delhi, India.

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Abstract

Introduction &c Objective: A 34 yrs. old male on conservative management for many years for refractory ITP 8c Chronic Renal Failure (CRF), reached ESRD in early 2001. He now needed a Renal Transplant Surgery as Maintenance Hemodialysis (MHD) was hazardous, and therefore, a splenectomy to make the Transplant safe. In view of the fact that open splenectomy would be dangerous & that platelets tend to rise almost with the ligation of the splenic artery, a laparoscopic splenectomy was decided upon. A single stage approach was decided upon as the increased cost of two operations would have included 2 sets of platelets also. Methods: Single donor platelets were arranged, Laparoscopic splenectomy was performed & the spleen brought to the RIF from where it was removed by opening the peritoneum through the incision made for Tx. Recepient surgery. The donor kidney was then transplanted with immediate diuresis. Total operative time was 3Vi hours. The platelet count was 8-15,000 during surgery; the clotting was serially monitored and found acceptable using a Thrombo-elastograph (TEG) machine. No platelets or blood was transfused during surgery. Results: All parameters improved from day 0. Platelet count went up to 1,00,000 on day 3, but came down and stayed at between 27-40,000 with normal graft function. Patient continues to do well 10 months after Transplant. Conclusion: Limited resources, refractory ITP with ESRD, confident laparoscopic splenectomy with expectation of on-table platelet count improvement, use of TEG machine & immediate diuresis all contributed to make this combined procedure less hazardous and successful. We believe it to be the first such procedure done. Following this we have performed a successful Renal Transplant, on another similar patient, doing the splenectomy laparoscopically a month previously. Patients of ITP need not be denied a Renal Transplant for fear of excessive bleeding.

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