Kamineni Hospital doctors perform kidney transplant between non-matching blood groups
Hyderabad-based Kamineni Hospital transplant team, which included nephrologist Dr Kamal Kiran and transplant surgeon Dr Srinivas Guttha, claims to have performed India’s first successful ABO incompatible (non-matching blood groups) kidney transplantation using the immunoadsorption technique.
The doctors transplanted the kidney of an A+ donor (father) to an O+ patient (son). The operation was performed on a Pune-based patient Deepak on July 19. A month after the surgery was performed, the patient is doing well, Dr B Shashidhar Reddy, CEO, Kamineni Hospitals, said in Hyderabad on Friday.
According to Dr Kamal Kiran, the ABO incompatible kidney transplantation is a rare procedure, but if protocols are implemented to transplant across blood-group barriers, an additional 1,500 live donor kidney transplants could be performed each year in India and 250 in Andhra Pradesh.
The ABO incompatible transplantation helps overcome antibody barriers to kidney transplantation. In the past, a transplant could not be successfully done unless the organ donor and recipient had compatible blood types. Because due to blood incompatibility issues, an estimated 30 per cent of related donors were turned down, said Dr Kamal Kiran.
It is estimated that kidney disease affects 1 out of 10 people. Kidney failure requiring dialysis affects 2-3 lakh people in India every year. About 17,000 patients receive some form of dialysis. Only 3,000 go through transplantation due to shortage of deceased-donors (formerly known as cadaveric) or non-compatibility of living donors. About 50 per cent patients on dialysis die in three years and 90 per cent in five years. In contrast, if 100 patients undergo transplant today, 85 of them are alive 10 years and beyond.
“An ABO incompatible transplantation is the best option for a patient who has no compatible donors in the family and the cadaver waiting list is long. Though an ABO incompatible transplant costs around Rs 8 lakh to perform, compared to Rs 3 lakh for an ABO-matched transplant, waiting on the cadaver list costs Rs 4 lakh every year,” Dr Kamal Kiran said.
Earlier, ABO-Incompatibility was an absolute contraindication to transplantation. However, due to medical advances and newer technologies, transplanting across any blood group is now possible. ABO incompatible transplantation involves two things; removal of existing antibodies and preventing rebound formation of antibodies.
Usual method of removal of existing antibodies has been plasmapheresis, which involves removing blood plasma from the body by withdrawing blood, separating it into plasma (which contain antibodies) and cells, and transfusing the cells back into the bloodstream.
A human adult may have a total blood volume of about 5 litres of which 2 litres are red blood cells, white blood cells and platelets. The remainder 3 litres are plasma that contains all protein, antibodies and clotting factors. Plasmapheresis removes these 3 litres. However plasmapheresis is crude and removes all antibodies, both good and bad. We need these good antibodies to protect us from infection. Thus plasmapheresis is associated with high risk of infection. In a transplant patient whose immunity has been lowered to prevent rejection, infection is a major problem.
So was born a new technique called immunoadsorption. A dialyzer column designed to ‘catch’ only the relevant antibodies (like anti-A group or anti-B group) is the answer. Now, anti-A or anti-B group antibodies constitute only 1-2 per cent of the total antibodies in plasma. However with plasmapheresis, 98 per cent of all antibodies are lost in the process of reducing these blood group antibodies. The new immunoadsorption technique removes only the anti-A or anti-B antibodies, thus sparing the good antibodies.
The ABO incompatible transplantations are currently being done cautiously in Sweden, Germany and US and regularly in Japan. About 2,000 ABO incompatible transplants have been done so far. The first cadaveric kidney transplantation was performed in the US in 1950. ABO-incompatible transplantation was performed as early as in the 1970s, but due to hyperacute rejection, results were discouraging. Recently published data, however, demonstrated an excellent long-term outcome of ABO-incompatible living donor kidney patients in Japan, bringing hope to several patients, according to the Kamineni Hospital doctors.
