What Is ABO Incompatible Kidney Transplant?
It is the procedure of kidney transplant from the donor to the recipient, even though the blood groups of the two do not match. Hence it is known as the incompatible transplant. A recipient’s body will always carry antibodies against the blood of the donor, so that as soon as it is given to the recipient, a rejection of the organ takes place. However, in this new method of transplant, the recipient is treated both before and after the transplant to reduce the level of antibodies in the body so as to make the transplant a successful one.
Causes of Kidney Transplant:
- Chronic renal failure cases where no urine formation takes place
- Renal carcinomas which turn malignant are required to be surgically removed. In such cases they need to be replaced for restoring the normal function in the body.
- Cases where dialysis fail
- Multiple cysts in the kidney which obstruct the normal pathway of reabsorption of nutrients and expulsion of the waste products
Signs And Symptoms A Kidney Transplant Is Needed:
- Increased blood sugar levels due to excessive re absorption of sugars back into the system. In such cases the insulin levels are normal.
- Excessive hypertension, the cardiac cycle and pathways also are normal. Fault lies in the functioning of the kidneys
- Failure in the use of a dialysis unit
- Experiencing symptoms of renal cancer such as blood or pus in urine, painful urination, less passage of urine, pain in the lower back region, diagnostic tests confirming the same.
Diagnosis Prior To Incompatible Kidney Transplant:
- Ideally a transplant requires a host of diagnostic tests to be run on the donor as well as the recipient. These include checking for the blood type whether A,B,O or AB group; human leukocyte antigen test HLA and the cross match test.
- However, the main aim of the ABO incompatible procedure is to transplant kidney irrespective of the blood group of the donor as well as the recipient.
- The only test that can be performed on the recipient is that the kidney he or she will be donating is free of any pathological conditions. For this purpose, blood tests, ultrasound imaging or x rays of the pelvic region may be needed for the recipient if at all a need arises.
Treatment Procedures For ABO Incompatible Kidney Transplant:
For a successful completion of the ABO incompatible kidney transplant, procedures are run on the recipient body prior to and also after the transplantation has been done. These majorly involve altering the antigen-antibody mediated response. This can be achieved with the help of following procedures:
Pre Transplant desensitization procedure:
- Therapeutic plasma exchange: The simplest and most common method to remove antibody from plasma is therapeutic plasma exchange, in which large amounts of plasma are withdrawn and replaced with colloid solutions. This procedure eliminates approximately 20% of the anti-ABO antibodies with each session. However, this technique is not sufficiently selective to remove only protective antibodies and also removes coagulation factors, hormones, and antiviral and antibacterial immunoglobulin G (IgG) and immunoglobulin M (IgM). However, this technique is by far the least expensive means of removing antibodies.
- Double filtration plasmapheresis and Antigen specific immunoadsorption: The selective techniques of double-filtration plasmapheresis or antigen-specific immunoadsorption are safe and more effective and are therefore usually the first choice. Because no coagulation factors are eliminated, large plasma volumes can be processed, and the resultant efficacy is increased compared to that of therapeutic plasma exchange. Using a second filter, double-filtration plasmapheresis is capable of eliminating the plasma fraction containing the immunoglobulins and decreases the amount of plasma discarded. Using the process of immunoadsorption, the plasma is processed through a Glycosorb ABO immunoadsorbent column and reinfused into the patient. There are no volume losses, and thus the number of adsorption cycles has no limit.
- Intravenous immunoglobulins: Intravenous immunoglobulin plays a role in the down regulation of the antibody-mediated immune response. The immunoglobulin blocks not only the Fc receptor on the mononuclear phagocyte, but also the direct neutralization of the alloantibody. Further, it inhibits the CD19 expression on the activated B cell, as well as that of the complement and the alloreactive T cell. Although alloantibody rebounds within days of the discontinuation of plasmapheresis, the benefit of intravenous immunoglobulin may continue for many months after drug administration.
- Splenectomy: This still remains a matter of controversy for a few physicians. A removal of spleen can be an important prerequisite of the desensitization protocol since it causes a heavy reduction in the antibody producing B cell pool.
- Quadruple immunosuppression: Immunosuppressive regimens are required for both T-cell-mediated immunity and B-cell-mediated immunity. Calcineurin inhibitors (cyclosporine and tacrolimus) and antimetabolites (mycophenolate mofetil and azathioprine) are mainly used with low-dose steroids. In addition, monoclonal or polyclonal antibody agents (anti-CD25 antibody or antithymocyte globulin) are also often used during the induction period. Anti metabolites seem to take seven to ten days to be efficient as in vivo immunosuppressants. Therefore, immunosuppressive therapy as desensitization should be started before transplantation in order to adequately inhibit antibody production.
- Anti-CD20 monoclonal antibody: The anti-CD20 monoclonal antibody, rituximab, directly inhibits B-cell proliferation and induces cellular apoptosis through the binding of complement.
Post transplant desensitization monitoring: The monitoring of anti-ABO antibody titer is critical for determining the effectiveness of desensitization and the optimum time to permit graft implantation. After transplantation, the anti-ABO antibody level must be monitored to detect its reaccumulation, which may indicate or induce antibody-mediated rejection. In patients with a higher rebound in serum antibody production after the incompatible transplant, desensitization therapy, especially antibody-depletion procedures, should be repeated.
Complications And Risk Factors Associated With ABO Incompatible Kidney Transplant:
- A lack of adequate oxygen environment may prevail for a few days in the body, coldness may persist
- Immuno suppression may increase the chances of super infections and also of opportunistic infections
- Bleeding may occur at the time of transplant
- Leakage of the renal artery ananstomosis can be seen, can become life threatening
Am I Good Candidate For ABO Incompatible Kidney Transplant?
At any age in your life, if the kidneys stop functioning well, you can consider yourself as an ideal case for the ABO incompatible kidney transplant.
After a kidney transplant assisted with ABO incompatibility, patient is kept under observation for a period of two weeks till the normal functioning of waste expulsion is achieved. If there are any symptoms seen of organ rejection (which seldom occur), the desensitization procedure needs to be started as soon as possible.
Surprisingly, the success rates for ABO incompatible kidney transplants are more as compared to the compatible kidney transplants by atleast 30 percent.
Following are the major advantages for choosing an ABO incompatible kidney transplant procedure:
- No need for cross matching for blood groups is needed
- No need for extensive tests to be run on donor and the recipient to check for the compatibility
- Can be done in emergency cases without having to wait for long or postpone the procedure of kidney transplant
Cost Comparisons For ABO Incompatible Kidney Transplant:
When the cost of the procedure of ABO incompatible kidney transplant is compared, it is seen that the price for the surgery inclusive of the follow up is nearly 40 percent lesser in India as compared to the other countries.
Why choose India?
Indian hospitals charge in peanuts for the surgical procedure if the rates are compared with the foreign countries. MedcureIndia promotes the Indian land for the same purpose with the same reason, with the intention of ensuring best treatment outcomes.