First-ever Pediatric ABO-incompatible renal transplant performed at Manipal Kasturba Hospital

Manipal: In a rare feat, Kasturba Hospital performed the first-ever Blood group ABO-incompatible renal transplant in a child who had renal failure and was on hemodialysis for the last six months.

A 14-year-old boy with a blood group O positive from Shivamogga was detected to have kidney failure 3 years back. Chronic kidney disease had progressed to advanced stages over the next two years, resulting in short stature and reduced physical activity. The child was referred to the Department of Pediatric Nephrology at Kasturba Hospital, Manipal for further care.

After evaluating the child, the family was counseled about the available treatment options. The family chose kidney transplantation with the father as a potential kidney donor and a matched blood group. However, on evaluation father was detected to be diabetic and could not be accepted as a kidney donor. Mother whose blood group was B positive, came forward for kidney donation and opted for an ABO-incompatible transplant. Such transplant requires removal of preformed antibodies from the child’s blood by plasmapheresis and the use of additional immunosuppression drugs prior to transplant.

Following completion of the necessary protocols, the child underwent an ABO-incompatible renal transplant on the 4th of January 2022 with support from Dr. Arun Chawla, Head- Department of Urology and his team and Dr. Shamee Shastry, Head-Department of Transfusion Medicine, and her team. The child was discharged on Day 10 with a well-functioning kidney.

The family was extremely satisfied with the outcome as they could see the mother-son duo walking to the hospital for regular follow-up visits with full of energy. The total cost was supported by State and Central Government funds which significantly reduced the economic burden on the family.

Dr. Shankar Prasad N, Head – Department of Nephrology said “The incidence of kidney disease and failure in children are increasing over the last few years. Early recognition, timely intervention, and long-term care are required in children with kidney disease. Dialysis and kidney transplantation are the only life-saving measures for failed kidneys

Dr. Dharshan Rangaswamy, Paediatric Nephrologist said, “In children with enormous growth potential, kidney transplantation is superior to dialysis and provides better quality of life. One of the major hurdles for kidney transplantation is finding a suitable donor. In presence of low rates of cadaveric donation, living-related donors are the main source of kidney among Indians. Blood group incompatibility is a key barrier to living kidney donation, which has been overcome effectively only recently. In children, performing ABO incompatible transplant, i.e. transplant, when blood groups are not matching, requires adequate resources and expertise”.

Dr. Avinash Shetty Medical Superintendent of Kasturba Hospital, Manipal said  “the newly formed division of Pediatric Nephrology at Kasturba Hospital under Dr. Dharshan Rangaswamy is well equipped to manage all complex kidney-related diseases in children. Dialysis, renal biopsy, and Kidney Transplant facility for children of all ages are available at Kasturba Hospital, Manipal providing the much-needed support for patients along the coastal belt and middle Karnataka”.