Hyderabad|India|August'2011: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.