50 year old man undergoes Kidney Transplant for second time
Kauvery Hospital successfully performs rare double antibody positive Kidney Transplantation
- The wife of the individual identified as donor had a blood group which was incompatible with the recipient
- The man also had high tissue antibodies due to the previous transplant
Chennai, 01 September 2022: Kauvery Hospital Chennai, a unit of Kauvery Group of Hospitals, a leading multispecialty healthcare chain in Tamil Nadu, today announced the success of double antibody positive kidney transplantation. This middle aged patient received successful kidney transplantation in spite of having two tissue destroying antibodies - first against the donor blood group antigens and the second against the donor's tissue antigens.
The man aged 51 years, had undergone the first kidney transplant 16 years ago in a private hospital in Chennai. He approached Kauvery Hospital with poor functioning of the transplanted Kidney following Cytomegalovirus infection (a viral infection) that occurred two years back.
Transplant kidney biopsy performed at Kauvery hospital revealed that his Kidneys were rejected on a long-term basis showing no chances of revival. He soon reached a stage where he needed dialysis support. The team of medical experts after a thorough evaluation, concluded that performing a second kidney transplant was the only way to save his life.
More complications surfaced on further evaluations, where he was found to have a high number of antibodies due to his previous kidney transplant. The antibodies were identified to be directed against HLA antigens, a type of molecule found on the surface of most cells in the body that play an important part in the body's immune response to foreign proteins.
His wife turned out to be the only available donor. However, another complication arose as both the donor and recipient had different blood groups. The patient's blood group was O, and his wife's blood group was A. It is normal for anyone to have antibodies against opposite blood group antigens.
Therefore he had antibodies against the wife's HLA antigens as well as to her blood group A.
Ideally, a Kidney Transplant requires the blood groups to match, as one person has antibodies against another blood group. If a transplant is performed with differing blood groups (ABO Incompatibility), the antibodies present in the patient's blood would react against the antigens in the donor blood group, present not only on the red blood cells but also on the surface of all other cells including those in the kidneys. The antibodies that are provoked lead to rejection of the organ at the time of transplant leading to an immediate failure which is known as Hyper acute Rejection. In the same manner the antibodies against the HLA antigens could lead to similar type of Hyper acute rejection.
The family was then counselled on the possible outcomes of the procedure as with anti-bodies against HLA and incompatible blood group antigens, there was a high risk of the kidney getting rejected during the surgery or in case of a successful transplant, anytime during the treatment post-surgery.
Apart from the CMV Infection, the individual was also being treated for TB for the last one year. Both these infections posed a threat of reducing the efficiency of the medication that was administered to reduce the antibodies in the man's system.
In case of a normal transplant, the medications to suppress the immune system is administered 24 hours prior to the procedure, however in this case, the medicines were given 2 weeks in advance. Treatments included administering medications that decreased the antibodies and performing Plasmapheresis, a process in which the liquid part of the blood, or plasma, is separated from the blood cells to remove the antibodies against the HLA antigens and the blood group antibodies and replace it with a plasma which does not contain antibodies. The individual was also being administered with anti thymocyte globulin on the day of the surgery.
These medications were instrumental in bringing down the antibodies against the incompatible blood group and against the HLA antigens. The Kidney transplant was successful with the organ function normally post procedure.
Speaking on the success of the transplant Dr. Aravindan Selvaraj, Co-Founder & Executive Director, Kauvery hospital Chennai said, "It is very rare for a person to have antibodies against two different components, one towards HLA, the other towards blood group and to have a transplant in such instances can be very challenging. However, our finest team of nephrologists and medical experts coupled with the state-of-the-art-facility, has made it possible to perform such complex conditions with better outcomes. Through this person's recovery, we want to convey people to not lose hope and consider the approach of seeking medical treatment with all confidence irrespective of complications such as re-transplantation, and incompatible blood group organ transplant. I would like to appreciate Dr R Balasubramanyiam, Chief Nephrologist and his team for saving a life irrespective of all the challenges that arose during the treatment".
The man was discharged ten days post-surgery with no complications or further traces of infection while the wife (the donor) was discharged the third day post-surgery.