The need for ABO incompatible kidney transplants :
Living donor kidney transplants in India are usually done with a healthy blood-related (close relative) donor from the family of chronic renal failure (CRF) or end-stage renal disease (ESRD) patient. The preferred living kidney donor must be of the same blood group as that of the recipient or of the universally accepted “O” blood group. In the past, If an ESRD patient did not have a donor of the same blood group or of the “O” blood group, there was no hope of having a kidney transplant. The recent path-breaking advancement in Kidney transplantation, an ABO incompatible kidney transplant in India has ushered hope for such ESRD patients. Many of the Top Indian kidney transplant hospitals offer ABO-incompatible kidney transplants in India.
India is one of the most favored countries for patients seeking a living donor kidney transplant in a well-equipped and well-managed kidney transplant hospital. Most Indian kidney transplant hospitals offer hassle-free and truly global-class kidney transplant surgery with success rates that are at par with the best Kidney transplant hospitals in the world. The reasonable cost of kidney transplant surgery with almost no waiting period has made Indian Kidney transplant hospitals a favorite place for kidney transplant needing foreigners.
The first successful Kidney transplant took place in India in 1971 at Christian medical college Vellore. Since then many Indian hospitals have performed successful kidney transplants year after year for Indian and foreign patients.
ABO incompatible kidney transplant in India:
India's first successful ABO kidney transplant took place in 2011 at Kamineni Super Specialty Hospital in Hyderabad city between a father son duo. Father, who was a living kidney donor had Blood group "A+" where as his kidney recipient son had a blood group " O+".
Now many Top hospitals in India are performing ABO incompatible kidney transplants in India for both Indian and foreign patients seeking kidney transplant in India.
ABO incompatible kidney transplants are universally accepted for those young ESRD patients who does not have a blood group matching donor.
ABO incompatible Kidney transplant involves desensitization of the recipient before the kidney transplant surgery to overcome the ABO incompatible antibody induced kidney graft rejection. For a successful and long lasting ABO-incompatible kidney transplantation, temporary elimination of the anti-ABO antibodies from the recipient's serum is an absolute must.
Desensitizing an ESRD patient before ABO incompatible kidney transplants :
The process of desensitizing an ESRD patient before ABO incompatible kidney transplants in India is aimed to reduce Anti A/B antibody levels to achieve titers between 1:8 and 1:32.
Desensitizing an ESRD patient before an ABO incompatible kidney transplant involves following key stages:
B- Cell depletion before ABO incompatible Kidney transplants :
Monoclonal antibody therapy with an anti-CD20 drug rituximab have eliminated the earlier practice of splenectomy. In addition therapy with rituximab, prior to ABO incompatible kidney transplant deplete B-cells and plasma cells by complementing dependent cytotoxicity (CDC) , and antibody dependent cellular cytotoxicity.
Apheresis before ABO incompatible kidney transplants:
The therapeutic apheresis is a cornerstone for ABO blood group incompatible kidney transplants.Therapeutic apheresis consists of separating and selectively removing the pathogenic material from the patient by an extracorporeal aphaeresis system. The two most common and universally accepted methods used for apheresis are:
1. Double-filtration plasmapheresis (DFPP):
Double filtration plasmapheresis is done by using two plasma filters. The second filter allows smaller molecules to return back to the patient. DFPP helps in avoiding many complications associated with the ordinary therapeutic plasma exchange. DFPP uses centrifugation or a plasma separator, and double-filtration plasmapheresis (DFPP).
Double filtration plasmapheresis technique aims at selectively removing the immunoglobulin fraction from the serum and minimizing the volume of substitution fluid required. Human plasma albumin is used in this technique is used as replacement fluid.
Immunosuppression is also started in pre transplant ABO incompatible recipients 7 days before the transplant surgery as a pre transplant conditioning. Immunosuppression drugs generally used in India for ABO incompatible kidney transplants are tacrolimus , mycophenolate mofetil and methyl prednisolone .
2. Immunoadsorption (IA):
Immunoadsorption is a more effective with least side effects in removing anti A/B antibodies. Immunoadsorption (latest the apheresis method) , combined with hemodialysis is used to decrease donor-specific alloantibodies in ABO incompatible kidney transplant recipients before kidney transplant. Different types of columns are used in the process.
- A Therasorb column contains polyclonal sheep anti-human IgG antibodies .
- Immobilized staphylococcal protein A using columns.
- Immobilized antigens and synthetic epitopes using columns
The major advantage of immunoadsorption over other apheresis techniques is that, it minimizes the need for replacement of factors such as albumin and plasma.
Studies demonstrate that Desensitization of the human-leukocyte antigen using this immunoadsorption procedure effectively reduced or eliminated donor-specific alloantibodies in 71% of patients undergoing ABO incompatible kidney transplants.
Rise in numbers of ABO incompatible kidney transplants:
Earlier the Living donor Kidney transplants were done with only donors having same blood group as that of the recipient. This was restricting the pool of available living kidney donor for an ESRD or CRF patient who were not having a matching blood group donor. Many ESRD patients who had a willing and healthy kidney donor from the family, could not have a kidney transplant because of blood groups not matching.
With the newer Plasma apheresis techniques and protocols that can successfully bring down the A/B blood group antibodies in ABO incompatible ESRD patients , It is possible now to have a successful Kidney transplant with an otherwise fit kidney donor having a different blood group.
Recent studies have shown that with proper pre transplant treatments for ABO incompatibility , patients undergoing the ABO incompatible kidney transplants have almost the same success rate as that of same blood group recipient and donor. Even the longevity of newly grafted kidney was found to be almost the same.
Which ESRD patients are ideal for an ABO incompatible kidney transplants :
Any ESRD patient who have a fit blood related living donor but with the different blood group can be considered for ABO incompatible kidney transplants. The feasibility of an ABO incompatible kidney transplant depends on the quantity of donor specific ABO incompatible antibodies present in recipient in the beginning , and how much the desensitization programs will help in reducing the ABO incompatibility induced antibodies.
If even after the desensitization programs the ABO incompatibility induced donor specific antibodies does not fall below the specified levels , doctors may not recommend an ABO incompatible kidney transplant.
Other parameters remains same as that in a same blood group matching donors.
An ESRD patient can not have a kidney transplant if he/she is having following medical conditions:
- An ESRD patient who is too weak and frail to cope up with surgery and post transplant management protocols.
- If the ESRD patient is known to have serious cardiovascular deficiency or has a recent heart failure or stroke episode.
- An ESRD patient who had a recent serious infection or cancer.
Precautions posts a successful ABO incompatible kidney transplant :
The Nephrology doctors team monitor the progress and functioning of newly grafted kidney in a successfully ABO incompatible kidney transplanted recipient.
The first two weeks are crucial after a successful ABO incompatible kidney transplant surgery for the acceptance of newly grafted kidney. After the first two weeks the chances of kidney graft rejection due to A/B blood group incompatibility induced antibodies start diminishing significantly.
Doctors recommend frequent blood tests to monitor the newly grafted kidney's function.
Post successful ABO incompatible kidney transplant the precaution remains same as that of a blood group matching transplants. To know more about precautions for a newly grafted kidney last your life time ,read our exhaustive blog on the subject.
Cost of ABO incompatible kidney transplant in India:
There may be variations in ABO incompatible kidney transplant cost . This variation could be because of the process of B-cell depletion , plasma apheresis or immunoadsorption techniques adopted for every individual patient.
|Cost of pre transplant investigations||800-1500 USD|
|Cost of Desensitization for reducing A/B blood group incompatibility induced antibodies (Conditioning)||6000-10000 USD|
|Cost of ABO incompatible kidney transplant||13500-15500 USD|
Why choose India for an ABO incompatible kidney transplant:
Many ESRD patients who do not have a blood group matching donor but an otherwise fit and blood related family member willing to donate a kidney for the patient are preferring India for ABO incompatible kidney transplants. The reasons for choosing India for ABO incompatible kidney transplants are as follows:
- The competency and expertise of Indian doctors.
- Globally at par success rates for ABO incompatible kidney transplants.
- Globally at par technological innovations and state of art infrastructure for conducting ABO incompatible kidney transplants.
- Lower cost of ABO incompatible kidney transplants in India.
- Comprehensive and well monitored and documented ABO kidney transplant programs.
- Prompt followup post successful ABO incompatible kidney transplant surgery in India throughout the lifetime of patient.
- Prompt start of treatment process .
- Low cost of accommodation rentals in the vicinity of treating hospitals.
Top Hospitals for ABO incompatible kidney transplants in India:
Although most of the reputed Indian hospitals offering kidney transplants, perform ABO incompatible kidney transplants for Indian and global patients. Here are the top Indian hospitals offering ABO incompatible kidney transplants.
Delhi-NCR ( National capital region) Hospitals offering ABO incompatible Kidney transplants:
Max super specialty Hospital Press enclave , Saket , New Delhi.
Indraprastha Apollo Hospital Jasola , New Delhi.
Medanta - The Medicity. Gurugram , India.
Sanar International Hospital Gurugram, India.
Manipal Hospital Dwarka , New Delhi.
Top Mumbai hospitals for ABO incompatible kidney transplants in India:
Fortis Hospital Mulund , Mumbai.
Global Hospital Parel, Mumbai.
Jaslok Hospital. Mumbai, India.
Top Bangalore Hospitals for ABO incompatible kidney transplants in India:
Manipal Hospital Bangalore,India.
Nu hospitals Bangalore, India.
Top Chennai hospitals for ABO incompatible kidney transplants :
Apollo Hospital Chennai, India.
Miot hospital Chennai, India.
Best doctors for ABO incompatible kidney transplants :
At CMCS Health , we are associated with top kidney transplant doctors for ABO incompatible kidney kidney transplant in India. We offer globally at par success rates in ABO incompatible kidney transplants in India.