A serendipiditous start to 2021

It was far from planned! The chance discovery that Dr Sanju Sobnach was a newly trained liver and kidney transplant and that he was spending a few weeks in Mauritius with his family led to our first meeting where he recounted his recent fascinating experience as a trainee transplant surgeon as well as his views on how kidney transplant could be relauched in Mauriitus after hiatus of 4 years. Dr Davy Ip opened the evening with a quick review of the state of kidney disease and history of kidney transplantation in Mauritius.

The Renal Association was honoured by the attendance of the Honorable Dr Kailash Jagutpal, the Minister of Health and Wellness, and several senior officials from the ministry.

The 40th Anniversary of the First Kidney Transplant in Mauritius

Today is a very special day to commemorate. Forty years ago, on the 17th December, the first kidney transplant was performed in Mauritius.

There are many remarkable aspects to this story. The surgery was performed in the Clinique Mauricienne by Dr Mahen Modun, urologist and Dr Marcello Li Sung Sang, nephrologist, both recently back from training at Dublin’s National Renal Unit. Helped by the paramedical staff, the sequential donor nephrectomy and transplantation took 4 hours.

What a daring feat! Such procedures are usually done by two different surgical teams in hospital settings with full diagnostic and therapeutic backup. The blood samples for cross match had to be sent to South Africa and the immunosuppressive drugs brought from Ireland. Try to imagine the medical scene in Mauritius 40 years ago.

Le Cernéen, 19 December 1980

In 1980, advanced renal failure was a death sentence. Dialysis had not started in Mauritius then. What was the chain of events that allowed the desperate 20 year old man suffering from oedema, breathlessness and high urea to find these two doctors? What led to the patient, the donor (his 18 year old sister) and their family to believe in the surgical intervention?

Since 1992, some 350 transplants have been performed in Mauritian public hospitals. Foreign teams started the transplantation programme and local surgeons took over. Unfortunately, the local transplant surgeons retired four years ago and patients have since been sent abroad for transplantation by the Ministry of Health and Wellness. Behind the scenes, there are serious efforts to restart local kidney transplantation with up to date standards and techniques in the near future.

Le Mauricien, 19 December 1980

One last detail about this great anniversary. The most amazing of all. Both the transplant recipient, now 60 years old, and the donor, 58 years old, are alive and well with the transplant kidney still working every minute…

Kidney Diseases, Treatment, Apprehensions, and Fears.

Kidney (renal) diseases are many and varied. What is commonly encountered in daily practice and what is feared by many patients is End Stage Renal Disease requiring dialysis. There are a lot of myths and half truths that I have encountered in my practice over the years. One of them is that “pou change ou du sang kan fer dialyse”, another one is that “dimoune mort kan fer dialyse” , yet another funny one is ” dimoune dire ki kan fer dialyse ki…” and so on…I shall dispel all these myths and half truths over the next posts.

The main complication of most kidney diseases is End Stage Renal Disease (ESRD), which is as the name suggests, the last stage of kidney failure, and the patient will now require dialysis. The main causes of ESRD are Diabetes Mellitus and Hypertension which are quite prevalent in Mauritius. Almost half of the Mauritian population is diabetic, or pre diabetic and a quarter of the population is hypertensive. This leaves us all at high risk of chronic kidney failure or disease (CKD), a condition in which the kidneys are irreversibly and permanently damaged and eventually renal replacement therapy will be needed.

There are five stages of CKD and that is graded mainly as per kidney function. The last stage of which is ESRD, a situation where renal replacement therapies should be considered. The treatment of choice for ESRD is a kidney transplant. A healthy compatible donor must be found and if all tests are ok, a surgery is done whereby a healthy kidney from the donor is removed and transplanted in the recipient (the patient with ESRD). It is worth pointing out that most people are born with two kidneys and only one is needed as such to maintain life. Hence this enables us to donate one kidney.

However very often, a potential donor is not found in time and thus the patient is left with no choice but starting on dialysis. This will be elaborated in a further post.

Guy’s Hospital Transplant Team working visit

During the third week of November, the Guy’s Hospital Transplant team came to Mauritius on a work visit to help to get the local kidney transplant programme reactivated. Kidney transplantlation in Mauritius came to a halt in 2016 with the retirement of the two local transplant surgeons.

This visit was organised by the Ministry of Health and Wellness (MOHW). The team consisted of Professor of Transplant Surgery Nizam Mamode of Mauritius parentage and Mauritius born Transplant Research Fellow Mr Benedict Phillips.

The four full working days consisted of meeting the Honourable Minister Dr K Jagutpal and appraising the potential transplant wards, operating theatres and the diagnostic facilities. There were meetings with various stakeholders and last but not least, workshops on legal framework and clinical protocols and pathways with senior MOHW officials and nephrologists (Dr K Fagoonee, Dr S Gaya, Dr D Ip).

The Guy’s Transplant team are also very eager to help with training local doctors, nurses and laboratory technicians. The local team will need to do further groundwork to meet their high standards before they can come over. Their plan is to help for a few years until the local team becomes autonomous.

Visit of Mr Jonathon Oldsburgh

Mr Jonathon Olsburgh, renal transplant and urology surgeon from Guy’s Hospital London, kindly gave a lecture to the Medical Update Group at the University of Mauritius on the 21st of August 2019 on the subject of Live Donor Kidney a transplant.

It was a succinct and enjoyable talk on a very relevant topic in the context of the developing cooperation between Guy’s and St Thomas NHS Trust and the Ministry of Health and Quality of Life to restart the local kidney transplantation programme.

It was very kind of Mr Olsburgh to sacrifice some of his holiday time to speak to us. It was only right he was presented with a little souvenir. There was a lively and long discussion at the end.