Kidney disease affects 1 out of 10 people. Kidney failure requiring dialysis affects 2-3 lakh people in our country every year. 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 huge a 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 eg: 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 rules would cause immediate rejection of the kidney. Due to this blood group divide, upto 30% of donors were deemed unsuitable earler. Non matching blood groups are called ABO incompatible. ABO – Incompatibility was and absolute contraindication to transplantation.
Not anymore! Due to medical advances and newer technological transplanting across any blood group is very 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 a lot of good antibodies to protect us from infection. This 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 (live 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 antibodies are lost in the procdd 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 continuously in Sweden, Germany, USA and regularly in Japan. Upto 2000 transplants in history. About 9 ABO incompatible transplants have been done so far in India.
Maruthi Biosciences is proud to announce the success of the first ABO – incompatible transplant using the Immunoadsorption technique for the first time in our country. The transplant team, Dr.M.Kamal Kiran, (Nephrologist) and Dr.Srinivas Gutha, (Transplant Surgeon) from Hyderabad successfully transplanted the kidney of an A+ve donor (father) to his O+ve son on 19/7/2011. The 34 year old son was suffering from kidney failure due to polycystic kidney disease and had no matching blood group donor in his family and hence his ABO – incompatible father stepped forward. They have so far done highest no of ABO incompatible kidney transplant in India with I.A. technique.
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. Till date 9 ABO incompatible kidney transplants have been done with Immuno Adsorption technique in India. Maruthi Biosciences is happy to declare that all of the patients are doing well.
ABO incompatible transplantation is hereby a routinely performed transplantation and is extremely successful. |
