Expanding the donor pool in Kidney Transplant
Dr. Sanjeev Saxena,
Head Dept. of Nephrology
Kidney transplant is a life saving treatment for kidney failure patients and now it can be easily done with almost 100% success. But the major problem with kidney transplant is shortage of organ donors. This contributes to growing transplant waiting list. Newer advancement in transplant techniques and medicines allow to do transplant in patients without blood group matched donor (ABO incompatible transplant) to increase the donor pool. At present this is available only at few centers like PSRI.
One of our patients, a 32 year old male presented to us with advanced kidney disease and was put on urgent hemodialysis. Need for kidney transplant was explained to patient but only blood group matched donor in the family was his mother. She was investigated and found unfit because of medical reason. After explaining the cost and long term outcomes of ABOi transplant, patient’s wife (blood group A+) was accepted as a donor. Patient’s blood group was O+ positive.
Patient was admitted about 2 weeks before provisional transplant date and immunosuppressant drugs started. Plasmapheresis was done to remove preformed antibodies against donor blood group antigen on alternate day basis. Plasmapheresis is a procedure in which plasma containing antibodies removed from the blood by a cell separator. Intravenous albumin and normal saline were used as replacement fluid. Each plasmapheresis was followed by intravenous immunoglobulin. Patient was dialyzed on alternate day basis during hospital stay. We checked routine blood parameters regularly.
After achieving minimum target antibody levels in the blood of recipient, kidney transplant was done. Patient started passing good amount of urine post transplant and there was fall in serum creatinine to normal level over next 3 days. Patient was discharged on post operative day 8 with serum creatinine of 1.0 mg/dl. Now he is 6 months post transplant and going for his work everyday.
OTHER FACILITIES FOR KIDNEY FAILURE PATIENTS AT PSRI HOSPITAL:
- Laparoscopic donor nephrectomy
- Donor swapping (when a living kidney donor is incompatible with the recipient, exchanges kidneys with another donor/recipient pair).
- Kidney transplant in complex cases (marginal donors, difficult vascular anatomy)
- Pediatric kidney transplant CRRT (slow continuous hemodialysis in hemodynamically unstable patients)