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The incompatible match

Four years ago, Rishikesh Batule, a 29 year-old farmer fromAkota, was diagnosed with kidney failure. With both kidneys failed, his life turned upside down, Batule struggled with the reality of medical check ups and dialysis as a part of his daily life. “I only had high blood pressure, and was a complete teetotaler,” Batule tells us over the phone from his village, where he grows soyabean and cotton on the two-acre plot of land that he owns.


Sixty five year-old Dharamchand Bandi, who opted for ABO Incompatible Kidney Transplant under Dr BV Gandhi in 2009, got his kidney from his 59 year-old wife Kumkum. Pic/Nimesh Dave

After a long wait for a donor kidney, in 2009, he came to Mumbai and met Dr Bhupendra Gandhi, a consulting nephrologist at Jaslok Hospital, who told him that his wait could be cut short if a family member offered to donate a kidney. “Nobody I knew matched my blood group, O negative,” recollects Batule, who was surprised when Gandhi told him that a kidney from a donor whose blood group was incompatible would also do if he opted for the ABO Incompatible Kidney Transplant.

Explaining the procedure, Gandhi — who was the first doctor in India in 1981 to have performed this technique — says, “The human body contains antibodies of the blood group other than his / her own. For example, a patient with blood group A will have antibodies for B group. Before an ABO Incompatible Kidney Transplant, the antibodies of the donor kidney are removed using a process called Plasmapharesis (see box). This is done five times before and three times after the transplant,” says Gandhi, adding that this period is called the accommodation period. The patient then has to take medicines throughout his/her lifetime to suppress the antibodies.


Pic/Bipin Kokate

Although an ABO Incompatible Kidney Transplant has been around for 20 years and carries a five per cent higher risk than a compatible transplant, the fact that it cuts down the wait for a donor has seen 59 such transplants being performed in the past three years, 10 to 12 of which have been in the past one year itself. “In any transplant, medicines are to be taken for life.

“In this procedure, all one has to ensure is that the production of antibodies is suppressed. Within a month, the organ adjusts,” says Gandhi.
Batule agrees. “We decided to go for the ABO Incompatible Kidney Transplant. It was better than waiting for a donor kidney, which, for all we knew, could take ages My mother, who is A-positive, donated her kidney,” says Batule, who now visits Mumbai every two months for a check up. He spent Rs 7 lakh on the procedure and now incurs a monthly cost of approximately Rs 10,000 on medicines.

Other commonly applied procedures include swapping kidneys — where couples with incompatible kidneys are brought in touch with other similar couples and kidneys are then cross-exchanged — which Gandhi says is not well-managed in India. But the prohibitive cost means that the number of ABO Incompatible Kidney Transplant cases in India is still lower than compatible kidney transplant cases. “The cost is almost double,” acknowledges Gandhi.
While Breach Candy Hospital and Jaslok Hospital are the only two hospitals presently conducting this transplant, Kokilaben Dhirubhai Ambani Hospital in Andheri (west) has patients who are undergoing the pre- transplant procedure and will go through the ABO incompatible transplant shortly under the initiative of Dr Shruti Tapiawala, a consulting nephrologist and a renal transplant physician at the hospital.

“I worked at University Health Network, Toronto, Canada for four years where we have done ABO incompatible kidney transplants on a regular basis. The five-year patient survival and the graft (transplant kidney) survival are equivalent to the blood group compatible living donor transplants.” says Tapiawala, who says this is a good option when the patient has a blood group incompatible donor. 

Dr Tapiawala advices a swap over ABO incompatible kidney transplant, where cost is an issue. “The quality and longevity of life after transplant is superior to dialysis,” say Dr Tapiawala. Although the risk and cost goes up, 65 year-old Dharamchand Bandi, who opted for ABO incompatible kidney transplant under Dr Gandhi in 2009, is a happy man today. “My creatinine was at a constant 7 (normal is 1) and I was put on dialysis thrice a week. After three months of dialysis, I knew I wanted to lead a normal life and needed to find another solution,” says the Goregaon resident, who resumed work in the sales department for a paper company a year after the transplant. Bandi, who received the kidney from his 59 year-old wife Kumkum, was the 18th patient in India to opt for the procedure. 

While the number of patients opting for this procedure has not seen a steep rise, it’s certainly finding favour as an option. “Patients should be aware that an incompatible transplant is possible today. Each case is different, and this could be a boon for a patient who is unable to find a compatible donor,” concludes Dr Shailesh Raina,who performed the transplant surgery on Batule and Bandi.  

The procedure
ABO Incompatible Transplant is an alternative to the increasing discrepancy between the number of available deceased donor organs and the number of patients on the waiting list The graft (the donor organ) and patient survival rates are better after living donor transplants  The survival chances after an ABO Incompatible Kidney Transplant are equivalent to that after a standard ABO compatible procedure for up to five years 

Drugs to prevent rebound of ABO-antibodies:
>Rituximad
>> Tacrolimus/MMF/prednisolone
>> IVIG
>> Postop preemptive immunoadsorption  

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