Today, a patient with pulsatile aneurysm(6cm x 4cm x 5 cm) at the left wrist near the site of arteriovenous fistula was referred to me by the nephrologist for consideration of excision. It is a pulsatile swelling and there are no visible dilated veins to confirm the patency of the arteriovenous fistula. It was difficult to do the Allen's test as the vessels seam to be calcified. I suggested the possible treatment of excision of the aneurysm after confirming potency of ulnar artery which is provider of major arterial supply to the hand. But, did not appear to be satisfied with my suggestion. He said he is on long list of medications(14) including immunosuppressives., as the creatinine is raising (2.3 mg). He said after kidney transplantation in 2004 (donor was his sister-in-law) he had long tumultuous period. Two more operations were done. One was hip replacement, the second was eye operation. He is a beneficiary of railway health scheme. He is not ready for the operative correction of the AVF aneurysm at left wrist region. I consoled him and said 'let us do the colour doppler scan and decide about the line of management later on'. He asked me what would happen if we leave it like that? I told him slowly that it can develop thrombus, embolism, rupture, endanger circulation to the fingers and compress the neighbouring nerve fibers. I thought he might ask me the next question, about the life expectancy in his condition. But he did not ask. During last 17years, he might have seen many ups and downs in his life from various angles. I told him once again, we will take decision during the next visit after seeing the duplex scan report. The patient left the consultation room, nodding his head reluctantly, it appeared the interview was incomplete. I could sense that he wanted to ask me many more questions, for which probably I do not have perfect answers. I waited for a minute, stretched my legs, closed my eyes and thought over the progress we made in the renal transplantation services in the last 50 years in India. Though, we made significant improvements there seems to be lot more to be done. I want you to read the progress that took place in renal transplantation in the paragraph below.
The history of kidney transplantation is a history of many unsuccessful efforts and setbacks, but also the history of perseverance, pioneering spirit, and steadfast courage. The first successful transplantation of a dog kidney was done by the Austrian Emerich Ullmann (1861-1937) in 1902. The kidney was connected to the carotid artery of the dog and the ureter ended freely. The organ produced urine for a couple of days before it died. In 1909, there were efforts to transplant human kidneys from deceased patients to monkeys and in the following year the first xenotransplantation in humans was completed. Different kinds of donors were tried: dogs, monkeys, goats and lambs, all without success. In 1939, the first transplantation from a deceased human donor was done by the Russion Yurii Voronoy, the patient survived for only a couple of days, and the organ never worked. In 1953, the first temporarily successful transplantation of a human kidney was performed by Jean Hamburger in Paris. A 16-year-old boy received the kidney of his mother as living donor transplantation. Then in 1954, a milestone was made with the first long-term successful kidney transplantation by Joseph Murray: the transplantation was done between monozygotic twins; the organ survived for 8 years. For his efforts in kidney transplantation, Murray was honored with the Nobel Prize in medicine in 1990. In 1962, the first kidney transplantation between genetically nonrelated patients was done using immunosuppression and in 1963 the first kidney transplantation in Germany was done by Reinhard Nagel and Wilhelm Brosig in Berlin. The aim of this article is to present the history of kidney transplantation from the beginning until today.
