Two Kerala brothers have recently undergone a unique kidney-swapping surgery to treat Autosomal Dominant Polycystic Kidney Disease (ADPKD). [1] This genetic disorder causes multiple fluid-filled cysts to grow in the kidneys, usually resulting in kidney failure. The revolutionary surgery not only reflects the progress of medical science but also provides hope for millions afflicted by ADPKD.
The brothers, both diagnosed with ADPKD, faced the grim reality of progressive kidney deterioration. Traditional treatment options include dialysis or kidney transplantation, but the shortage of suitable donors often delays transplantation. [1] Fortunately, the unique compatibility between the siblings presented an opportunity for a direct kidney swap.
During this process, both brothers donated one of their healthy kidneys to each other, thus substituting the affected organs with healthy ones. [1] This method bypassed the long wait for donor kidneys and reduced the risk of organ rejection since they were genetically related. Doctors also managed to maximize immunosuppressive therapy, further promoting the success of the transplant. [1]
ADPKD is among the most prevalent life-threatening genetic conditions, occurring in about 1 in 1,000 people globally. [2] It is characterized by the development of multiple cysts in the kidneys that increase in size over time, leading to pain, hypertension, and eventually kidney failure. [2] Over 50% of patients with ADPKD progress to end-stage renal disease (ESRD) by age 50, necessitating dialysis or a kidney transplant. [2]
A kidney transplant is the ideal treatment for patients with ADPKD who progress to ESRD, as it offers a higher quality of life and better survival rates than dialysis. [3] However, the limited supply of donor kidneys remains a significant challenge. In some cases, preemptive kidney transplantation—carried out before the patient progresses to dialysis—has resulted in superior long-term outcomes. [3]
Another aspect of managing ADPKD is native nephrectomy, i.e., the surgical removal of diseased kidneys. It may be required before transplantation if the kidneys become abnormally large, causing significant discomfort or complications. [4] However, nephrectomy must be carefully assessed, as it carries surgical risks. [4]
The success of this kidney exchange surgery demonstrates the promise of novel medical interventions in treating complex hereditary conditions such as ADPKD. The genetic relationship between the siblings minimized the risk of organ rejection, enhancing recovery after transplantation. [1] This case also highlights the value of tailored treatment plans, which may pave the way for the broader application of such procedures. [3]
References
Onmanorama. 2025. "Rare Kidney Swapping Surgery Done in Kerala for Brothers with ADPKD." Onmanorama, February 23, 2025. https://www.onmanorama.com/lifestyle/health/2025/02/23/rare-kidney-swapping-surgery-kerala-adpkd-inherited-condition.html.
PKD Foundation. n.d. "What Is ADPKD?" PKD Foundation. Accessed February 2025. https://pkdcure.org/what-is-adpkd/.
PKD Charity. n.d. "Kidney Transplant." PKD Charity. Accessed February 2025. https://pkdcharity.org.uk/adpkd/treatment/kidney-transplant.
Nephrology Dialysis Transplantation. 2025. "Nephrectomy in Autosomal Dominant Polycystic Kidney Disease: A Systematic Review-Based Consensus Statement." Nephrology Dialysis Transplantation, January 2025. https://academic.oup.com/ndt/advance-article/doi/10.1093/ndt/gfaf019/7977013.
(Input from various sources)
(Rehash/Pragati Sakhuja/MSM)
