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Comment by mikecsh | Hacker News Reader

I don't think this can be the whole story. Normally when a kidney is transplanted into a patient, the defective kidneys are not removed (adds unnecessary risk). There is plenty of space to add a kidney without removing the spleen so there must be more to this!

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Yep, and in particular it's not difficult to get sufficient access to circulatory system.

http://my.clevelandclinic.org/health/treatments_and_procedur...

We definitely need more info.

EDIT: Actually, looks like it was in fact an issue of space and blood vessels. From the Google-translation of the Italian article linked elsewhere in the comments:

> The particular malformation of the baby made it impossible for the kidney system donated by the classic conventional technique. The only option then was to use another way of connecting to the bloodstream....In order to create the necessary space for the new kidney, a revolutionary surgical technique which involved the removal of the spleen and the installation of the kidney on splenic vessels of the spleen itself along their course behind the pancreas was applied. The ureter of the transplanted kidney was then implanted directly on the bladder.

https://translate.google.com/translate?sl=auto&tl=en&u=http%...

Oh how interesting! Thanks for the link!

Sounds like (from the Italian article) she had already had an unsuccessful (or attempted?) kidney transplant in 2014. The patient appears to have some sort of vascular as well as immunological issues (again, my broken translation from the Italian).

When the donor kidney isn't a blood-type match for the recipient, I believe you can do the transplant with a splenectomy and plasmapheresis to eliminate pools of immune cells and desensitize the immune response to the incompatibility, but I believe that splenectomy has largely been replaced by treatment with rituximab (antibody-drug that targets immune B cells). Perhaps the combination of congenital vascular issues plus incompatibility in this patient made the transplant + splenectomy approach preferable?

Very short summary of another Italian article [1]:

The child is 6. She's needed dialysis since she was born. She never drank water, to prevent problems.

There was an unsuccessful transplant in 2014, because of the immune response.

They couldn't risk another transplant using the blood vessels of the kidneys. She was also at risk of not being able to keep doing dialysis because of the problems to those blood vessels. Because of all of that, they decided to remove the spleen and use its blood vessels for the new kidney. She urinates normally now and she can drink water.

I couldn't find information about the issues with the blood-type mismatch.

[1] http://torino.repubblica.it/cronaca/2016/12/14/news/torino_t...

Her young age, and thus minimal body development, may have limited the extra space needed...?

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