Organ transplant across blood groups now a reality

Dr. P.V.A. Mohandas, Managing Director, Miot Hospitals,with Rajan Ravichandran, director, Miot Institute of Nephrology (right), at a press conference in Chennai on Saturday. Photo: R.Shivaji Rao  

Questioning the basic rules of science is responsible for some of the more fantastic cures in medical history. Performing organ transplantation across blood groups will probably fit into this category.

Three months ago, Rajan Ravichandran, Director, MIOT Institute of Nephrology, and his team, pulled off such a feat as they used a kidney from a donor with ‘B' blood group on a recipient with ‘O' blood group. Normally, that would have killed the patient on the operating table. Not this time though. Using a special procedure called Double Filtration Plasmapheresis (DFPP) evolved by the Japanese, the team had the patient, S, discharged in a week, and back at his software job in three months' time.

Dr. Ravichandran says: “The most essential requirement in transplantation is a blood group match. Ideally, the patient's own blood group, or, in the event it is not available, any group for which his blood does not carry antibodies.” Antibodies are used to detect and neutralise foreign bodies, being the base for both allergy and immunity in the human body.

While ‘O' is a universal donor, it has antibodies to ‘A' and ‘B' groups; similarly, ‘A' has antibodies to ‘B'; and ‘B'group, antibodies to ‘A'. Only the ‘AB' group, a universal recipient, has no antibodies. The Rhesus factor (+ve, –ve) is irrelevant in the transplantation process. Tissue matching is also not done for most ‘cadaver transplants' and the availability of new generation immunosuppressant drugs has helped patients tide over that mismatch, Dr. Ravichandran clarifies.

If the right blood group is not chosen, the moment the recipient's blood begins to flow into the transplanted organ (which will continue to harbour micro red blood corpuscles from the differently matched donor's kidney), it will turn blue and will be rejected by the body. Patient S (with blood group ‘O') had a donor in his father, who was in ‘B' group. Thanks to the Japanese technology, the team removed the specific antibody (in this case, ‘B') in the patient's blood through the DFPP process over three sittings.

Meanwhile, titres to measure the presence of antibodies in the blood were done periodically. At the right time, the transplantation surgery was fixed. Post transplantation, the patient received special monoclonal antibody rejection injection to prevent new antibody formation. This process does not compromise the health of the patient in any way, Dr. Ravichandran adds.

The MIOT team comprising Ashok Shakthivel, transplant surgeon; A. Kanakaraj, nephrologist; C.N. Srinivas – Head, Immunlogy Department; N.K. Ganesh Prasad, nephrologist, headed by Dr. Ravichandran completed this procedure, which costs about Rs.3.5 lakh (against the conventional transplantation cost of Rs.2.5 lakh) on patient S.

In Japan, where the technology was evolved, over 450 successful cross-blood-group transplantations have been perfomed, he explains. The success at a 10-year survival rate is equal to that of any regular kidney transplantation. At the Mayo Clinic in the United States, over 40 such transplants have been performed using a different technique. Closer home, while several attempts at cross-blood-group transplantation have been made over the years (including by Dr. Ravichandran), success was noted only six months ago at Christian Medical College, Vellore.

This process can be used across various organ transplants, Dr. Ravichandran says, adding that it could also help people who have rejected a transplanted organ many years later because of antibody formation. With lakhs of people with end stage kidney disease in India, there are only 5,000 transplantations that occur in a year. While efforts are being made to increase the donor pool, strategies such as DFPP would increase the chances of saving lives, Dr. Ravichandran states.

P.V.A. Mohandas, managing director, MIOT Hospitals, stresses on the need to communicate the tremendous possibilities of such procedures to the public. With a high burden of diabetes and hypertension in the population and the consequent impact in the number of people with kidney disease, efforts must be taken to make transplantation available to more people, he adds.

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Printable version | Jun 10, 2021 6:47:43 PM |

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