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Departments Nephrology Kidney transplant across blood group - PATIENT HISTORY

 

 


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.

 

Kidney Transplant across Blood Group


MIOT Hospitals performed the successful Kidney Transplant Across Blood Group (Successful Kidney Transplant from B blood group donor to O blood group recipient)

 

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 was taken up for preconditioning with the Japanese technology. This removes the antibodies against the blood group. Simultaneously he received drugs to prevent new antibodies. Once his blood antibody titers came down drastically, the fathers 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.

 

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 than 1000 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 womens university who are the leaders in blood group mismatch kidney transplantation. The other center which is also increasingly performing mismatch transplantations is the Mayos 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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