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ABO incompatible kidney transplants in India.

ABO incompatible Kidney transplants in India - CMCS health.

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 investigations800-1500 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
Cost of ABO incompatible kidney transplant in India .

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 - Best Indian hospitals for ABO incompatible kidney transplants | CMCS health.
Max super specialty Hospital
Press enclave , Saket , New Delhi.

Indraprastha Apollo Hospital - Best Delhi hospital for ABO incompatible kidney transplant | CMCS health.
Indraprastha Apollo  Hospital
Jasola , New Delhi.

Medanta = The medicity - ABO incompatible kidney transplant in India - CMCS Health.
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

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.

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Pyeloplasty – UPJ obstruction treatment.

Dr ( Prof.) Anant Kumar - Urologist | Kidney Transplant Surgeon is regarded as the best and most experienced Kidney Transplant Surgeon of India and Director-Urology,Kidney Transplantation and Robotics at Max Hospital,Saket,New Delhi,India.

What is Uretero-pelvic junction Obstruction?

Uretero-pelvic junction obstruction occurs when the flow of urine from the renal pelvis to proximal ureter have an obstruction. The condition may lead to Hydronephrosis. Hydronephrosis is a medical condition ,where the kidneys are swollen with urine because of narrowing or blocking of ureters. Ureters empty the urine from kidneys into urinary bladder. The resultant back pressure within the renal pelvis may cause progressive kidney damage or deterioration of kidney function.

Uretero-pelvic junction obstruction may appear in children due to a congenital abnormality or even in adults following any previous surgery or any other medical condition that causes inflammation of upper urinary tract.

What causes pediatrics UPJ Obstruction ?

The exact cause of pediatrics uretro pelvic junction obstruction is still not known. Many times the defect is present in an unborn baby and is termed as congenital defect. It is diagnosed during routine prenatal ultrasound.

There may be many reasons for UPJ obstruction during the gestation period. some of them are:

  • During the developing phase the child's ureter is not fully formed resulting in a narrowed section of ureter which may be blocked later on.
  • A faulty muscle in ureter wall which may not squeeze normally.
  • Formation of a "Crossing Vessel" ,i.e., an additional artery feeding the kidney of developing fetus. This may result in kinking or blocking of the ureter.

It can have a genetic component,i.e., it runs in families .Although the responsible gene is not identified yet.

What are symptoms for pediatrics UPJ Obstruction?

Sometimes a UPJ Obstruction in a child does not have any symptoms. A UPJ Obstruction in a developing fetus is usually observed during a routine prenatal ultrasound. It is detected because of hydronephrosis. In majority of cases it is corrected on its own after the child birth.

But in moderate to severe condition the following symptoms may occur and they do need a medical attention as if left untreated,it may cause a permanent damage to kidney or urinary system of child.

  • The renal pelvis or kidneys or both are dilated (hydronephrosis).
  • Abdominal,back or flank ( sides) pain.
  • Frequent UTIs ( Urinary tract infections).
  • Edema
  • Swelling around eyes.
  • Lump in abdomen ( Abdominal mass).
  • Poor or retarded growth in infants.
  • Fever.
  • Rashes.
  • vomitting.
  • Bloody urine or diarrhea.
  • Abnormal urine output.

How UPJ Obstruction is diagnosed?

If Hydronephrosis is observed in a developing fetus during a routine prenatal ultrasound , doctor in charge for delivery of child will do more periodic ultrasound to keep a close vigil on any complications arising of the present medical condition.

Many times this medical condition is resolved on it's own ,once the child is born. But the doctor may do following tests after a few week of birth of child.

  • Creatinine clearance.
  • BUN ( Blood urea Nitrogen).
  • CT Scan.
  • Electrolytes.
  • CT- Urogram.
  • Nuclear scan of Kidneys.
  • Voiding cystourethrogram.
  • Ultrasound.

What causes UPJ Obstruction in adults?

The reasons for UPJ obstruction in adults may be due to scar tissues,infection,any previous surgery or renal calculi (Kidney Stones).

The other reasons may be:

  • A previous renal pelvic trauma.
  • Obstructing calculus immediately distal to PUJ.
  • Previous pyelitis with scarring.
  • Intrinsic malignancy,e.g. upper tract urothelial carcinoma.
  • Extrinsic ureter compression due to


1. Fibrosis.

2. Crossing vessel at PUJ.

3.An underlying malignancy.

Symptoms of UPJ Obstruction in adults:

Adults may experience following symptoms because of UPJ Obstruction:

  • Renal colic.
  • Chronic back pain.
  • Other non specific signs may be hematuria,Urinary tract infections and pyelonephritis.

Treatment Options:

Treatment line depends on presence of underlying cause.In Majority of congenital cases,no intervention is required and the condition subsides after some time however in case of a definite structural obstruction ,surgical intervention in the form of pyeloplasty or stenting may be needed.

Surgery is also inevitable in case of deterioration of renal function or when associated symptoms are severe and progressive.Aim of treatment is to normalize renal drainage and if possible,improve if  reversing the damage to kidneys is not possible.








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