Breaking Down Barriers: Overcoming Obstacles in Organ Donation and Transplantation

When faced with an inevitable situation wherein a kidney transplant has to be performed between a donor and the recipient with different blood groups, ABO incompatible kidney transplantation (ABO I KT) offers a possible solution.

Things once considered impossible have become possible with medical evolution and ABO I KT is one such evolution, because transplanting across different blood groups was considered an absolute contraindication until 1980s.

In early 2000, ABO I KT gained popularity in Japan and Europe, later spread across the globe. Over the last decade, various transplant centers across Karnataka have successfully performed ABO I KT.

We performed our first case of ABOIKT in early 2018 at Columbia Asia Hospital, Yeshwanthpur (presently Manipal Hospitals). The case was challenging since it involved convincing the whole system as it was first of its kind and needed co-ordination between teams of Nephrology-Transplant surgery-Blood bank – Technicians and others. It was a gratifying experience as the patient did extremely well after transplant and this motivated us to perform more such transplants.

Over period of years, we have developed our own protocol for ABO I KT which could be tailored as per the recipient’s clinical profile. Till date, we have performed 40 ABO I KTs with good outcomes.

Its all about ISA

Isoagglutinins titers (ISA) against the donor blood group are of paramount importance in the process of ABO I KT and its removal during peri transplant period is the cornerstone for success of these transplants. ISA removal can be done by the following- ISA suppression (rituximab) and ISA eviction (plasmapheresis or immunoadsorption).
Process involved

Estimation of isoagglutinin titers using gel card method, pre transplant and planning the suitable method of ISA eviction is important and the number of sessions of PP or IA depends on baseline ISA titers and the patient profile. Target titers to be achieved are 1:8 or less on the day of surgery and we chose to do PP/IA if titers rebound more than 1:64 during first one week after transplant.

Immunosuppression involved is ATG as an induction agent and triple immunosuppression as maintenance regimen.
After 7-10 days accomadation of the graft kidney with the different blood group happens and the recipient body accepts organ as it’s own.

Dr. DEEPAK KUMAR CHITHRALLI, Senior Consultant Nephrologist And Transplant Physician, Manipal Hospital Yeshwanthpur