The Department of Transplant and Immunology, a sub unit
of the MIOT Institute of Nephrology has the expertise to
provide the best Kidney Transplant programme. The unit
has experience in handling transplants and problems
arising from them, for over many decades. The success
rate of a transplant here is comparable to the best in
the world today. Since its inception this institute has
performed 85 successful kidney transplants.
A team of doctors headed by Dr. Rajan Ravichandran
preformed a blood group mismatched kidney transplant
successfully on 23rd Feb 2010. The patient - a young
software engineer having ‘O’ blood group, received
kidney from his father aged 64 years having ‘B’ blood
group.
The patient was suffering from chronic kidney disease
and was on CAPD for more than 2 years (already his
brother who was also suffering from kidney disease had a
successful kidney transplant with his sister being the
donor). Now when he also developed kidney failure, the
parents did not have the matching blood group. The
father was keen on donating his kidney although he was
64 years and had a different blood group.
When
possibility of blood group mismatch transplantation was
put to the family, the father was extremely eager to
donate his kidney. After doing the regular
investigations which showed the father to be fit, the
patient was admitted in the hospital. His blood was
tested for the anti-A and anti-B blood group titers. He
underwent a special Japanese procedure called DFPP
(Double Filtration Plasmapheresis) which removes the
antibodies against the blood group. Simultaneously he
received drugs to prevent new antibodies. Once his blood
antibody titers came down drastically, the father’s
kidney was removed and the transplantation was done on
23rd Feb 2010. On the table there were a few tense
moments since the fathers kidney had extra veins which
resulted in prolonging the warm ischemia time (warm
ischemia time is the time from clamping the blood supply
to the kidney till perfusing it with cold saline). This
resulted in a little delay in the kidney function after
transplantation. However it was pink and firm and the
surgery was completed. Post operatively the patient
started passing urine after few hours and the kidney
function returned to normal over the next few days. His
blood group antibody titer continue to remain low. The
patient and father both were discharged from the
hospital in a healthy condition with normal functioning
kidneys.
DFPP (Double Filtration Plasmapheresis)
Normally the basic requirement for successful kidney
transplantation is a match in the blood groups. A person
with A, B, AB or O blood group can receive kidney either
from ‘O’ or from the same blood group. So a person with
‘O’ blood group is a universal donor. However he cannot
receive kidney from any other person other than ‘O’.
That is because his blood contains anti-A and anti-B
antibodies. Hence the kidney would get rejected
immediately on the operating table. Over years there has
been tremendous technological development whereby these
antibodies are successfully removed so that blood group
mismatch transplantation can be performed. It is also
important to prevent future antibody production. This
was done by removing the spleen which normally produces
antibodies. There are also drugs available to prevent
antibody formation.
The largest
number of blood group mismatch transplantations (ABO
incompatible) has been performed in Japan. More than400
patients have undergone this procedure with success
rated equivalent to normal kidney transplantation. This
Japanese technique involves DFPP and drugs to prevent
antibody formation. MIOT has been collaborating with the
Tokyo women’s university who are the leaders in blood
group mismatch kidney transplantation. The other center
which is also increasingly performing mismatch
transplantations is the Mayo’s clinic in USA who has
performed more than 30 such transplants. We can be proud
that MIOT can also offer this specialized treatment in
India.
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