In a significant development, a team of doctors at Max Super Specialty Hospital (MSSH), Mohali has surpassed blood group barrier with special immune-modulation and desensitization protocol while performing region first successful ABO-incompatible, a different blood group kidney transplant. Interestingly till date blood group matching between donors and recipients was essential for kidney transplant. Due to this limitation, many of the patients of Chronic Kidney Failure (CRF) were deprived of transplant (the best treatment modality) even if a suitable and willing donor was available in the family. Thus many patients had to continue on dialysis lifelong or get a kidney from unrelated or brain dead donors, which would be very distressing for the patients and their family members. Under ABO incompatible the donors of A & B group can donate to O group recipients with ease.
The hospital feat, which is maiden blood group mismatch barrier success in Northern India, has given hope to hundreds of kidney patients waiting for a transplant in the absence of a donor with a matching blood group in this region.The patient Mr. Vijay Kishore Singh, who is himself a doctor from Patna, had undergone kidney transplant in August 2011, with his father being a donor. His blood group is O-positive, and none of the other family members, except his 65 years old father had similar blood group. Due to old age of the donor the kidney again failed (graft loss) after 2 years following transplant. Back on dialysis, Vijay was suffering a lot. Unable to bear the sufferings of her husband, Vijay’s wife having A-positive blood group came forward to donate one of her kidneys to him. They enquired all over India, but each time, transplant was denied due to blood group mismatch. With this new technique a team of doctors led by Dr. Sananda Bag, Urologist & Transplant Surgeon and Dr Munish Chauhan, Consultant, Nephrology at MSSH Mohali have successfully transplanted a kidney of the wife to her husband. Mr. Singh has been discharged with normal kidney function and is doing well now.
Dr Bag informed that in cases of kidney failure, the first option for kidney transplant was via family donor. In case the blood group of family donor did not match, then the second option was via donor swapping between two families. But if somebody failed to find the third option, then his or her life became critical, remarked Dr Bag. Dr Chauhan said that initially there were situations, in which the patients of kidney failure would have a family donor, but their blood groups did not match, so medically, kidney transplant was not possible. But now we have potent and advanced medicines with the help of which we could do even the non-blood group matched kidney-transplantation."
In India about 60 per cent to 70 per cent of kidney failure was due to unrecognized diabetes and blood pressure. So, those who were hypertensive, diabetic, obese, smoker and above 50 years of age should opt for regular check-ups, pointed out Dr Chauhan.Elated with the success of his surgery, the patient Mr. Singh said that my appetite was lost, could not drink liquids even if I was so thirsty, and I felt too weak to walk as my haemoglobin level was very low. Despite being on regular dialysis, my conditions deteriorated several times and I was on constant medications to increase blood formation. I was distressed and depressed by the sufferings, so much so that I just did not want to live. We enquired at many centres in Kolkata, Hyderabad, Chennai and Delhi and were denied transplant due to blood mismatch. The prominent Hospitals in Delhi gave huge estimate of Rs. 15-16 lakh for such transplant which was not affordable for me, said Dr Singh adding we were grateful to the clinical team at MSSH who have taken on the challenge and painstakingly dedicated themselves to alleviate my sufferings. Post surgery I could feel much better, able to eat and drink normally and feel as strong as before, he asserted. Dr Chauhan informed further that we took on the challenge of ABO incompatible transplant considering no other suitable donor available for Vijay. We strictly followed international guidelines and treatment protocols to ensure success. This became possible with over all support from other allied specialties such as Transfusion Medicine. Long term result of ABO incompatible transplant was similar to routine compatible transplant. Although blood compatible kidney transplant was always preferred, it became imminent at times to take such challenges for patients not having a blood group matched donor in the family.”
Dr Bag said that this was a breakthrough event and landmark in transplant in this region, especially for many suffering and distressed patients of kidney failure who didnt have a suitable or blood-compatible donor in the family. As majority of the population having O-blood group, number of patients with CRF having O-group was high. Due to non-availability of a suitable O-group donor in the family, such patients usually have to wait long for getting a kidney from a brain-dead donor or unrelated donor, and suffer a lot on dialysis (may be for lifelong). The legal formalities for unrelated donors kidney transplant was very stringent, non-hassles-free and time consuming – thus many of such patients die of kidney failure while waiting to get a kidney. Now onwards many such patients could undergo hassle-free kidney transplant from their family donors without restriction of blood–matching, maintained Dr Bag.Talking about organ donations, Dr Bag commented that each year more than 1 lakh new patients developed kidney failure in our country and more than 5-lakh patients were on dialysis, waiting for transplant, but transplant took place in only about 5000 cases due to shortage of donors. To meet this huge gap we needed to encourage more and more organs donation from brain dead persons (following accidents / brain stroke) in addition to donors swapping and ABO-incompatible transplants. Donating a kidney was safe and did not hamper somebody’s life or activity. Now days donor’s operation was done laparoscopically, which was less painful, enabled faster recovery and early return to work, and was more aesthetic, Dr Bad remarked. Talking about the shortage of organs in the country, Dr Chauhan said that after having successfully launched the blood group incompatible transplant , the MSSH would be starting the Brain-Dead donor kidney transplant program very soon.