Like many nephrologists, Dr Unni was drawn to nephrol- ogy by a duty of patient care after four years of general practise, on seeing “the difficulties faced by patients on dialysis”. There can be few transformations more dramatic than that of patient recovery following trans- plant, of which Dr Narayanan has witnessed many, having conducted more than 1100 transplant procedures over the course of a 34 year career.
Prior to specialising in trans- plantation, Dr Unni‘s career path- way began in India, leading him to the Christian Medical College, Vellore and to the P.G.I. Chandi- garh, both centres of excellence for renal transplantation in India; here, he lectured students as well as dealt with the demands of the busy casualty and intensive care units. Dr Unni was an exceptional student, and was awarded both the Gold Medal awarded by Mala- bar Christian College, Calicut for the First Rank in the University in 1973 and the Gold Medal for the Best outgoing student of Calicut Medical College in 1978.
Dr Unni still recalls his first transplant at Dammam Central Hospital, Saudi Arabia. The 25-year-old patient received a kidney from her brother, and involved some of the most challenging procedures of his career. “Kidney transplantation in children is very challenging; however, it is extremely rewarding. Results of kidney transplantation in children are even better than those in adults, if this is done by an experienced team.” The youngest child for which Dr Unni’s team has performed a transplant was below 2 years of age at the time of transplant, and he often meets his former patients; “The longest survival in my experience is 34-years (kidney donated by the patient’s sister); both donor and recipient have a normal kidney function even now, and come to me for regular follow up.”
Many developments in techniques have occurred since Dr Unni’s first transplant, and Dr Unni has been at the forefront of surgical methods development, writing a number of papers detailing the outcomes of case studies employing new robotics procedures, as well as detailing unusual cases and their outcomes, such as procedures in patients with congenital abnormalities of the kidney and urinary tract. Although Dr Unni is familiar with reports of the development of an Implantable Artificial Kidney, he cautions that “The artificial kidney is still in the experimental stage; this would need more refinements before it can be widely used in patients.”
There are ongoing difficulties in India in encouraging living donors to come forwards despite first degree blood relatives typically providing optimal matches, and the number of deceased donor kidney transplantations in India is unfortunately too small to meet the demand. Dr Unni has been an outspoken advocate of both living and deceased donor organ donation within The International Transplantation Society and at international conferences around the world;
“It is very important to propagate the concept of organ donation from brain-dead persons, so that several people who are suffering end stage renal disease can have a second lease of life. The quality of life after a successful kidney transplant is much superior to the life on dialysis.” Not only does Dr Unni have a passion for improving patient outcomes and returning quality of life to those undergoing dialysis, but he considers it “our duty as medical personnel to educate people about the benefits to the society by promoting and encouraging deceased donor kidney transplantations.”
Dr Unni emphasises the importance of adherence to lifestyle and post-operative care advice following transplantation; “If the patient (recipient) is not careful with his medications, follow up and his lifestyle, the results may not be good.” His advice to patients and early career nephrologists is as follows:
Diet and exercise - It is extremely important for the patient to have a disciplined life style
Immuno- suppressant medicines – These need to be taken regularly as advised by the Nephrologist
Anxiety, depression and mental health – this is usually not a problem, as long as the kidney is working well.
Kidney rejection - The incidence is very low, if the donor is a first degree blood relative.
Lifestyle changes - It is very essential to ensure that body weight does not increase. Smoking is to be avoided, and regular exercise is essential.
Dr Narayanan Unni is currently the Lead Senior Consultant in Nephrology and Urology at Aster MedCity, Kochi, where he initiated the kidney transplant programme and established the DNB programme in Nephrology.