renal transplant

At a private hospital in the city, a COVID-19 survivor had a rare renal transplant with a kidney from a donor with a different blood group.

The 29-year-old man with ‘B’ blood group received a kidney from a donor with ‘A’ blood group. Renal transplants are usually done with matching blood groups. There are four groups – A, B, AB and O.

R. Balasubramaniyam, chief nephrologist, Kauvery Hospital where the transplant was doine, said a kidney transplant predominantly involved donations among compatible blood groups.

“If the transplant is performed with different blood groups, the antibodies present in the patient’s 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),” Dr. Balasubramaniyam said.

The hospital tried the ABO incompatible transplant by reducing antibodies in the blood through treatments before and after transplant. Since the patient recently recovered from COVID-19, antibodies against SARS CoV-2 virus were naturally present in his blood.

The challenge for doctors was to ensure that SARS CoV-2 antibodies were not lowered so that he did not become vulnerable to infection. They lowered blood group antibody through plasm-apheresis to protect the new organ. The patient was monitored and the transplant was done when the donor and recipient were physically fit.

The donor was discharged three days after the surgery while the recipient was discharged after being kept under observation for one more week, to monitor any abnormalities in kidney function and infections. The patient was discharged a week later. “He is now leading a better quality of life,” Dr. Balasubramaniyam said.

ABO incompatible kidney transplant advanced and complex requiring expertise and treatment methods, he added.

Aravindan Selvaraj, hospital’s executive director, appreciating the team,said: “ABO incompatible kidney transplant accounts for less than 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 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.”