 Hello friends, I am Dr. Sanjeev Rahagyi, clinical lead of Hepatobiliary and Liver Transplant Surgery at Manipal Hospital, Whitefield. Today I will tell you a bit more about the dual organ transplant. Instead of one organ being transplanted, we transplant two organs. It can be either liver plus kidney or it can be kidney plus pancreas. I would tell you about the patient who underwent liver and kidney transplant simultaneously. Dr. Ravi Shankar, I have shown you that my kidney treatment has started. After three months of dialysis, my kidney transplant planer, Babastha, and other people who are ready for it, Dr. Sanjeev Rahagyi and other doctors have shown me that my liver is at a very high level. I am Dr. Ravi Shankar, consultant nephrologist at Manipal Hospital, Whitefield, Bangalow. I have seen Mr. Bajan Sarkar, who is a 55 years old gentleman. He has come to me in the month of August and September. I found him to have severe kidney failure because of diabetes and hypertension. Therefore, we started him on dialysis. In addition to kidney failure, he also found to have liver dysfunction, for which I have referred him to Dr. Shiv Kumar, the gastroenterologist, and then where we found him to have hepatitis C infection. For hepatitis C infection, he has been started on medications and then the liver functions got slightly better. But however, the liver biopsy had shown that he has severe liver failure. And therefore, myself and Shiv Kumar discussed and then referred him to Dr. Sanjeev, the liver transplant surgeon. And we all together, myself and Dr. Sanjeev and Dr. Shiv Kumar, has decided that since he had both liver failure and kidney failure, we listed him for combined liver kidney transplantation. And fortunately, within few months, he got a cadaver liver kidney organ, and then he underwent a liver kidney simultaneous transplantation on 9th of July. Hi, I am Dr. Nikhil Shalagi. I am a consultant, heptabilitant transplant surgeon at Manipal Whitefield. Today, here with us is Mr. Bajan Sarkar, who was diagnosed to have chronic kidney failure requiring dialysis. But during work up, he was advised to undergo kidney transplant. But then during work up, we found that he's got liver disease and which is decompensated. So only kidney transplant was not a solution. And he had required both kidney and simultaneous liver transplant. Since he did not have any donor for liver, so the surgery was deferred for at least six weeks. So meantime, we thought that we would get him registered for cadaver donation. So once he was registered for cadaver donation, the government placed. He was lucky enough to get the organ within three months. I'm Dr. Nitya. I'm intensivist in Manipal Hospital, Whitefield. So in our unit, we do liver transplant as well as kidney transplant regularly. But this is the first case of combined liver and kidney transplant that we have done. So these patients, they require more intensive ICU management. Infection control practices have to be very stringent in these patients. And also they might require dialysis in the post-operative period, which makes it different compared to the other liver transplant patients. Hi, I'm Dr. Shokumar. I'm a consultant in medical gastroenterology at Manipal Hospital, Whitefield. This patient presented to us with chronic kidney disease for which he was undergoing regular hemo dialysis. So on presentation, he was detected to have hepatitis, which was not there before, which he would have acquired somewhere outside during the dialysis as well. So when he presented to us with acute hepatitis C, with very high viral load, we evaluated him and started him on directly acting anti-viral agent for which he responded well initially. But because of chronic kidney disease and other comorbidities that rapidly progressed to colostatic hepatitis, which manifested as severe itching and jaundice, which later progressed and his liver decompensated. But we continued on the medications, provided him symptomatic treatment, and we were able to control the disease severely. But in his case, his kidney was the primary problem and then the liver was also affected. So we did the biopsy. On the biopsy, there was stage 4 fibrosis and approaching to cirrhosis. He decompensated in the form of water in the tummy that is called a cytis. I actually confirmed that we had to do a dual transplant for this patient. When we do two transplants, it requires more planning. Two teams are involved. The liver kit team is involved, kidney team is involved. He has to undergo dialysis just before the transplant. The immunosuppression, the medicines which we give after the transplant, they also change the bed and the protocols are different. And I won't go into details of all that. But it is more intensive and we have to be for next two, three weeks after the transplant, we have to closely monitor him, then the patient recovers. I'm really happy to see his recovery. He was quite a bad shape having dialysis thrice a week. And the liver was also damaged with water in his tummy and he also had jaundice. It is really heartening to see that he has recovered well. And I really congratulate my team, the nephrology team, the urologists, my colleagues, and above all the intensive care and anesthetists who have made dual organ transplants also possible in Whitefield. Manipal Hospital, Whitefield. I was very impressed by the treatment of this patient. The total staff of the hospital who took care of us in ICU, the nurses and junior doctors who took care of us at our gate, I was very happy and proud of that. I started my treatment at Manipal Whitefield Hospital as a doctor who helped me. I was very happy and proud of the treatment of the patients. But the four doctors who took care of me continued. Dr. Rabishankar Sir, Dr. Siddh Kumar Sir, Dr. Sanjeev Sir, Dr. Nikhil Sir, Dr. Sanjeev Sir. Thank you for your support.