Incompatible  Non matching blood groups  Kidney Transplantation  using the  Immunoadsorption Technique  performed in Hyderabad based Kamineni Hospital
While there are 2 3 lakh kidney failure patients in India  a meager 3000 patients go through kidney transplantation due to shortage of cadaver donors or non compatibility of living donors
It is estimated that an additional 1 500 live donor kidney transplants could be performed through this procedure each year in India  This marks a new chapter in treating renal failure
Hyderabad  August 19 Hyderabad based 350 bedded Super Specialty Hospital  Kamineni Hospital transplant team comprised of Dr  Kamal Kiran  Nephrologist and Dr  Srinivas Guttha  Transplant Surgeon successfully transplanted the kidney of an A donor  father  to an O+ patient  son  which was earlier supposed to be impossible  Termed ABO Incompatible Kidney Transplantation in medical language  this is the first ever such operation in the country done using the Immunodadsorption Technique  Non matching blood groups are called ABO incompatible  The operation was performed on a Pune based patient Mr  Deepak on 19th July here in at Kamineni Hospital in city  announced Dr  B  Shashidhar Reddy  M S  CEO  Kamineni Hospitals
Kidney transplantation or renal transplantation is the organ transplant of a kidney into a patient with end stage renal disease  Kidney transplantation is typically classified as deceased donor  formerly known as cadaveric  or living donor transplantation depending on the source of the donor organ  Living donor renal transplants are further characterized as genetically related  living related  or non related  living unrelated  transplants  depending on whether a biological relationship exists between the donor and recipient
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 lakhs to perform  compared to Rs  3 lakhs for an ABO matched transplant  waiting on the cadaver list costs Rs  4 lakhs every year  declared Dr  Kamal Kiran  Nephrologist addressing a press conference here in city today  With this the dream of a kidney transplant  regardless of the matching has become a reality  bringing hope to several patients  he expressed as a sense of pride
The procedure helps us 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% of related donors were turned down
Adding further Dr  Kamal Kiran stated that the ABO kidney transplantation is a rare procedure  but if protocols were implemented to transplant across blood group barriers  it is estimated that an additional 1 500 live donor kidney transplants could be performed each year in India and 250 in Andhra Pradesh
Dr  Srinivas Guttha  Transplant Surgeon says  Kidney disease affects 1 out of 10 people  Kidney failure requiring dialysis affects 2 3 lakh people in our country every year  About 17 000 patients receive some form of dialysis  Only 3000 go through transplantation  50 per cent patients on dialysis die in three years and 90 per cent in five years  If a 100 patients undergo transplant today  85 of them are alive 10 years and beyond  In Andhra Pradesh we have nearly 30 000 kidney failure patients and only 500 go through the kidney transplantation  On the other hand deceased donor formerly known as Cadaveric  has long waiting list  Last year while 600 patients were on waiting list for deceased donor kidney in Andhra Pradesh  only 40 people got a kidney
The long term healthier and cheaper option for these patients is transplantation  The source of a kidney is either a related donor or cadaver donor  accidental brain dead donor   With a huge shortage of cadaver donors  related donors are preferred  Most patients on the cadaver list die waiting for a kidney  Related donors  father  mother  siblings  spouse  cousins  in laws  usually step forward to donate
However  even if they are deemed medically fit to donate  they are rejected if their blood groups are not matching  For e g  blood groups A and O can donate to A; B and O can donate to B; anyone  A  B  AB and O  can donate to AB; and only O can donate to O  Any transplants done against these rules would cause immediate rejection of the kidney  Due to this blood group divide  upto 30% of donors were deemed unsuitable earlier  Non matching blood groups are called ABO incompatible  ABO Incompatibility was an absolute contraindication to transplantation
Not anymore! 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  Plasmapheresis means removing the patient s plasma  which contain antibodies   A human adult may have a total blood volume of about 5 liters of which 2 liters are red blood cells  white blood cells and platelets  The remainder 3 liters are plasma which contains all protein  antibodies and clotting factors  Plasmapheresis removes these 3 liters  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% of the total antibodies in plasma  However with plasmapheresis  98% of all antibodies are lost in the process of reducing these blood group antibodies  This new Immunoadsorption technique removes only the anti A or anti B antibodies  thus sparing the good antibodies
Across the world ABO incompatible transplantations are being done cautiously in Sweden  Germany  USA and regularly in Japan  About 2000 transplants have been done in history so far   About 6 ABO incompatible transplants have been due thus far in India The first cadaveric kidney transplantation was performed in USA in 1950  ABO incompatible transplantation was already performed as early as in the 1970s  but due to hyperacute rejection  results were discouraging  But  due to a severe shortage of available deceased donor organs  most ABO incompatible kidney transplantations have taken place in Japan  Recently published data demonstrated an excellent long term outcome of ABO incompatible living donor kidney patients in Japan  Similar successful short term results have been shown for protocols developed in Europe and the United States  But  these protocols need to be standardized
Kamineni Hospitals has created a new chapter in Kidney Transplantation in India by the success of an ABO incompatible transplant using the Immunoadsorption technique  A month after the surgery was performed  the patient is doing well  It is a matter of pride for Andhra Pradesh
Though initially the ABO incompatible transplant costs around Rs 8 lakhs it will come down if the volumes go up  The higher cost when compared to traditional compatible kidney transplant is due to the cost of the extra medications and the Immunoadsorption device  But  for a patient with no ABO matching donors  the costs of prolonged dialysis  while waiting for a cadaver transplant and the risks of dialysis  more than nullify the extra cost of an ABO incompatible transplant  Now at Kamineni Hospitals the dream of a kidney transplant  regardless of the matching has become a reality  bringing hope to several patients  The news of this new procedure must reach more people to give them hope to live their life