Beyond Blood types - ABO Incompatible Kidney Transplant in a patient suffering from Hepatitis infections

A 28-year-old woman from Dhaka, Bangladesh, Ms. Afshan Jahan’s (name changed) life was profoundly affected by end-stage renal disease. A mother of two daughters, Ms. Afshan faced grave health challenges due to her failing kidneys. Despite 2 year-long struggle, there was no improvement in her condition due to a lack of adequate dialysis access and concurrent infections. Adding to the woes, her fistula failed, necessitating repeated and painful catheter insertions. Gradually Ms. Afshan lost significant weight, reaching a mere 35 kilograms with a severely compromised ability to perform daily life activities. Furthermore, she was deemed ineligible for kidney transplant in her home country and a few hospitals in India as well. Seeking specialized care, a hopeful Ms. Afshan reached Manipal Hospital Varthur Road, Bengaluru.

At Manipal Hospital Varthur Road, Dr. Garima Aggarwal, Consultant–Nephrologist and Renal Transplant Physician, and a team of eminent doctors thoroughly assessed Ms. Afshan’s case, diagnosed her suffering from both Hepatitis B and Hepatitis C-infections, which are dangerous and can cause liver failure and promptly initiated therapies for her hepatitis infections. These infections in addition with kidney failure make kidney transplant very challenging

Expert’s Comments – Dr. Garima Agarwal says “Nowadays it is rare to see Hepatitis B or Hepatitis C in patients undergoing long-term dialysis treatment, because of improved hygiene and infection control practices. Even more rare and dangerous to have co infection with both the viruses Multiple needle pricks, repeated dialysis sessions and lack of strict adherence to infection control practices probably lead to the patient acquiring both the infections. In the past having hepatitis was considered contraindication for going ahead with kidney transplant”

Doctors at Manipal Hospital Varthur Road realized that it would be difficult for Ms. Afshan to survive in her dire situation unless she received a kidney transplant. They found a donor in Ms. Afshan’s brother, but unfortunately, the blood groups did not match. However, the undeterred team of experts embarked on the complex path of an ABO-incompatible kidney transplant in a dual hepatitis positive patient.

About ABO incompatible kidney transplant – ABO incompatible kidney transplant is different from the regular kidney transplant. Here, the donor kidney is of a different blood type than the recipient. Normally, for a safe transplant, it’s important that both the donor and recipient have compatible blood types to avoid the immune system attacking the new organ. However, with advances in medical treatments, it’s now possible to perform transplants even when the donor and recipient’s blood types don’t match, called ABO incompatible transplants. Doctors use special techniques to “reprogram” the body’s security system temporarily, making it accept the new organ with a different blood type without setting off alarms. This involves medication to make the immune system less reactive to the different blood types and special procedures called plasmapheresis to remove antibodies that might attack the new organ.”
Although ABO incompatible kidney transplant was an answer for Ms. Afshan’s condition, there were considerable risks owing to her existing health complications, particularly given Aisha’s existing hepatitis infections. With tailored treatment and medical expertise of Dr. Aggarwal and the team, unwavering support from the family, and Ms. Afshan’s resilience, the treatment was successful and with each passing day, Ms. Afshan gained strength and vitality.

Expert’s comments – Dr. Garima Agarwal says, “Ms. Afshan’s road to recovery, normalized kidney function, treated hepatitis infections, and restored quality of life is a testimony to the transformative power of specialized multidisciplinary medical care and organ transplantation and a reminder that even in the face of adversity, hope prevails, illuminating the path to healing and recovery.” She also adds that ABO-incompatible kidney transplants increase the availability of potential donors for patients who would otherwise have to wait for a compatible match, adding new hopes to kidney transplants. However, the procedure carries risks and needs careful monitoring and management throughout the transplant process.