First-of-its-kind transplant in Chennai (TN) for a COVID recovered patient
The donor and recipient belonged to blood groups B and A respectively
ABO incompatible transplants accounts to <1% of overall kidney transplants in India
Kidney transplant generally requires matching of certain medical parameters between the donor and patient, and blood group comes high up on that list. Often, the donor and the patient belong to the same blood group, or the donor could belong to O blood group (Universal Donor). However, with recent advancements in the transplant realm, ABO incompatible transplants are offered in some experienced centers, to prevent longer wait time for patient on dialysis.
Kauvery Hospital Chennai, a unit of Kauvery Specialty Hospitals, a leading healthcare chain in Tamil Nadu, performed a successful ABO incompatible kidney transplant on a 29-year-old man. Speaking on this patient, Dr. R Balasubramaniyam, Chief Nephrologist, Kauvery Hospital Chennai says, “A kidney transplant predominantly involves a donor and patient who belong to compatible blood groups. If the transplant is performed with different blood groups, the antibodies present in the patients blood would react to the donor blood group antigens that are present not only on the red blood cells but also on the surface of all other cells including those in the kidneys. The antibodies that are provoked may lead to rejection of the organ at the time of transplant leading to immediate failure (called Hyper acute rejection). In this innovation of ABO incompatible transplant, the antibodies present in the blood are reduced through treatments given before and after transplant.”
The patient had recently recovered from COVID-19 and hence the antibodies against the infection were naturally present in his blood. “We started the treatments of lowering the antibodies, two weeks prior to the transplant, but the challenge here was that we had to ensure the COVID antibodies were not lowered significantly making him vulnerable to infection. Therefore, we worked on providing treatments that lowered the blood group antibody and some medications to protect the new organ from antibodies. The existing antibodies in blood stream were lowered through plasmapheresis and medications were injected through intra venous route (Intravenous Immunoglobulin and Anti Thymocyte Globulins) to suppress the cells from producing more antibodies,” he adds.
Upon regular monitoring and tests, we found both the donor and patient to be physically fit, and the antibody count in the patient was ideal for the transplant. “The transplant was successful and donor was discharged within 3 days. The patient was kept under observation to monitor any abnormalities in Kidney functions and detecting infections. After a week the patient was back home, and he is now leading a better quality of life,” added Dr. Balasubramaniyam.
An ABO incompatible kidney transplant is a more advanced and complex procedure that requires the right expertise and treatment methods. In this scenario, the team of experts will help the patient to prepare his body much prior to the transplant, depending on the antibody count in his blood. Post-transplant care is also crucial, as the patient has to be monitored for smooth function of the Kidney and also it has to be ensured that the patient is free from infections.
Speaking on the successful transplant, Dr. Aravindan Selvaraj, Co-founder and Executive Director, Kauvery Hospital Chennai says, “ABO incompatible Kidney transplant accounts to <1% of overall kidney transplants in India. However, there are still significant number of patients with kidney failure on dialysis who do not find the blood group compatible donor on time. This technique of ABO incompatible transplant helps such patients to get the transplant done at the right time, thus avoiding longer wait time and poor quality of life. Our department of Nephrology-Urology work hand in hand to offer a comprehensive treatment for patients with end stage renal failure. I congratulate Dr. R Balasubramaniyam and team for helping the patient to lead better quality of life.“