Kidney Transplant with Different Blood Group

Kidney Transplant! A boon to save a person from the clutches of death!! There is no other option but dialysis or kidney transplant when the kidneys, which are constantly cleaning the blood, separating the wastes and toxins, and sending them out in the form of urine, are completely exhausted. Among these, kidney transplant is the best. But the major problem is non-availability of kidney donors in required number. Another problem is blood group mismatch even if donors are found. This is where the process of ABO Kidney Transplantation comes in handy. Its specialty is that it enables safe kidney transplantation even if the blood group is not compatible. So its importance is increasing day by day.

Many metabolisms are constantly happening in our body. During this process, many toxins and wastes are been produced. Some of these are also found in the blood. Our body will be healthy only if these are removed from time to time. Otherwise it becomes like a pile of garbage. This is what happens when the kidneys fail. At the last stage of renal diseases, Dialysis or a kidney transplant is the only refuge when medication are no longer of any benefit. But even with peritoneal dialysis done at home, or hemodialysis done with a special device in the hospital, only 50-60 percent of the blood is purified. Patient has to visit hospital three times a week for hemodialysis. Financial burden is high and also there is a risk of infection. Daily life becomes chaotic due to this. That is why kidney transplants are preferred first if donors are available. It works just like a natural kidney. Quality of life and life expectancy both increases. But currently only 5% of those who are suffering from kidney failure are able to get transplantation. The main reason for this is the lack of donors. As per the Organ Transplantation Act family members can donate their organs. The organs of the deceased can also be transplanted. However, even if the donors are found, the blood group does not always match. Sometimes family members Blood groups can also be different. About 40% of kidney donors belong to this different group. It is estimated that about 2.20 lakh people require kidney transplant or dialysis every year in our country & only 7,000 to 8,000 of them are able to get kidney transplant. All the others are undergoing dialysis and waiting for the organs of the deceased. By the time a kidney is found in a deceased person, some are unable to be transplanted due to complications such as heart failure. ABO Incompatible kidney transplantation is a boon to such patients.

WHAT WILL HAPPEN WHEN THE BLOOD GROUP IS DIFFERENT?

Blood matching between donor and recipient is very important in kidney transplant. Our blood has A, B, AB and O groups. Group A contains A antigen (protein that produces antibodies) and antibodies that reject group B. Group B contains antibodies that reject group A. AB group has both A and B antigens. There are no antibodies that reject other groups. So anyone's kidney can be transplanted to them. Group O has no antigens, so they can donate kidneys to anyone. But because of the presence of antibodies that reject the A and B groups, they need an O group kidney transplant. If the kidney is transplanted from someone with a different blood group, the body will reject it. Our immune system constantly fights off foreign invaders like bacteria and viruses. Trying to drive them out. When an organ is transplanted from someone with a different blood group, the immune system treats it as a foreign enemy. Anti-blood group antibody titers (ABO/AB) try to attack and expel it. ABO incompatible kidney transplantation procedure avoids such risk. Its specialty is that it removes antibodies from the blood of the recipient of the kidney, even if the donor's blood is different. This enables safe kidney transplantation.

HOW DO WE DO IT?

First, a blood test measures the number of neutralizing antibodies. If these are in 1:8 ratio then there is no clinical complication. Some may have antibodies in the ratio 1:16 to 1:128, 1:256. These are removed by the process of plasmapheresis. This should be done 3-4 times because the ratio gets decreases gradually with treatment. Plasmapheresis is done until this ratio reaches less than 1:8. If the antibodies are too large, immunoadsorption will be suggested. Once the antibodies reach within 1:8 the transplant is done like a normal kidney. Rituximab injection is also given two weeks prior to plasmapheresis. This is very important. It is imperative to prevent the production of new neutralizing antibodies.

AFTER TRANSPLANTATION

Antibody testing is not necessary if kidney function is good in the first few weeks. Antibody test is done if kidney function is reduced. Rejecting antibodies are usually produced within two to four weeks after a kidney transplant. If the number increases, plasmapheresis is needed again. If rejection antibodies develop four weeks after transplantation, there is no harm. By then the body owns the kidney. It works like a natural kidney. It is remarkable that it works like a kidney taken from a person with matching blood group. Normally, kidneys taken from blood group matched individuals function smoothly in 97-98% people. Kidney transplants from blood group mismatched individuals are also 96% successful after plasmapheresis.

MANY BENEFITS

When donors of the same blood group are not available, this ABO process involves transplanting a kidney of a different blood group. Otherwise, we have to wait for the kidney of the deceased or you will have to undergo dialysis for the rest of your life. It is noteworthy that many of those who undergo dialysis die before a kidney is found. Therefore, ABO incompatible transplants can be truly life-saving procedure when dialysis patients are unable to find a blood group-matched kidney.

CLINICALLY ADVANCED PROCEDURE

Actually ABO incompatible kidney transplantation process is not a new procedure. It started in Belgium in the 1960s and 70s. But, back then the results were not so good. About only 75% of kidney transplant recipients were successful. At that time, the entire spleen was removed. High doses of immuno suppressants were also given. This would cause infections quickly. As advanced treatments become available, the process is getting better and better. Especially with the introduction of Rituximab injection, the situation has changed a lot. This made it possible to perform a kidney transplant without removing the spleen. Results also improved. Currently, 40% of kidney transplants in Japan are performed with this procedure. According to the Japanese law, the organs of deceased persons cannot be transplanted. Because the number of donors is very low, ABO incompatible transplantation is gaining importance.

PRECAUTIONARY MEASURES MUST BE FOLLOWED STRICTLY

Organs taken from others, whether matching blood group or not our body tries to reject it. So, immunosuppressants has to be taken for rest of the life. In the first three months, they are given in slightly higher doses. Then slowly we can reduce to normal dose.

• Taking immunosuppressant drugs increases the risk of infections. So be careful. Especially in the first three months, do not go to crowded places. Always wear a mask. If anyone in the house has cold or fever, they should stay away from them.
• Always eat cooked food. Do not eat canned food.
• The most important precaution- regular use of medicines. Many people think that everything is fine after a kidney transplant. It is good to regularly consult your doctor. After three or four months, some people stop testing, thinking that the doctor is giving them the same medicine whenever they go. After another two months, they stop taking the medicine assuming that everything is fine. It is very dangerous. This is the main reason why transplanted kidneys don't work effectively.
• If you take proper care you can live comfortably like everyone else. There are ladies who got pregnant and gave birth to children after the transplantation.

REGARDING DONORS

Besides blood group, there are many other factors that have to be taken into consideration before transplantation.

• People with diabetes that may lead to kidney disease in the future, even if their kidneys are fine now, are not eligible for kidney donation. Also, people suffering from high blood pressure which damages the kidneys should be monitored with care. Kidney can be donated only if blood pressure is controlled with one drug and there are no other complications. If the blood pressure is high and more than one medicine is being used, they are not eligible for donation.
• Our kidneys filter 70-80 milli liters of blood per minute. This is called EGFR. If it is at least 70 & equal in both the kidneys, only then he/she is eligible for donation. If one has high EGFR and the other has low EGFR, it is not suitable for donation.
• Even if the kidney function is good, if there are other problems like heart, lung diseases, donor might not tolerate kidney removal surgery. Such people are not suitable for kidney donation.
• If there is a possibility of stone formation in kidneys, such donors are not eligible

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