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ABO Incompatible Renal Transplant

Renal transplantation is the treatment of choice for patients with end stage renal disease. Unfortunately, the number of end stage renal disease patients on waiting list is increasing while the number of available kidneys is static. To overcome the shortage of organs, various strategies have been developed among which ABO incompatible renal transplant is one of such strategy.

ABO incompatible living donor renal transplant is a strategy in which renal transplant is done by breaking the ABO blood group barrier. Usually for a successful renal transplant, the donor and patient should be compatible for Human Leukocyte Antigen System (HLA compatible) and ABO blood group, but by implementing advanced desensitization protocol and potent immunosuppression therapy the ABO blood group barrier can be effectively broken and transplantation can be done is such cases.

ABO incompatible renal transplants have been successfully done in developed countries like US and Japan, similarly such complicated cases are successfully done in handful of centers of India to name such like Apollo Delhi, Medanta Delhi etc.

The renal transplant case being treated at Yashoda Hospital Secunderabad was suffering from end stage renal disease since many years, the patient had HLA matched donor (wife) but their blood groups were not matching. The patient’s blood group was O and donors blood group was B. In this case the patient was having Anti B in his plasma which would not allow donor kidney (B) to be transplanted under normal circumstances, and on the other hand the anti B titers in patient plasma were quite high i.e., 1:1024. To decrease the titer to safe levels multiple plasmapheresis (average 8 sessions) procedures were required to bring the titers to below 1:8.

We at Yashoda Hospital Secunderabad successfully carried out ABO incompatible renal transplant by implementing advanced plasmapheresis protocol using Glycosorb Immunoadsorption Column, which brought the ABO antibody titers to 1:4 before transplant in mere 2 sessions. Such transplants are rarely performed in Hyderabad and nearby areas whereas, desensitization by Immunoadsorption Column is performed for the first time in Hyderabad as they are inherently associated with higher risks as compared to ABO compatible transplants.