The first ABO-incompatible kidney transplant at the Apollo hospitals Chennai was done by using the Immune adsorption columns to reduce the specific blood group antibody titer before the ABO-incompatible transplant. This is the first case in the country using column adsorption of blood group antibodies .
What is Column Adsorption Technology?
Traditionally ABO compatible donor organs are essential to achieve a successful organ transplant. Transplantation of solid organs like kidney between donors and recipients of incompatible blood group is usually contraindicated because of the risk of “”hyper acute”” rejection. This rejection occurs due to the presence of pre existing Anti-A or Anti B antibodies in the recipient that can destroy the incompatible donor organ.
Limitations in donor availability for organ transplantation makes “”living donor”” solid organ transplantation across the blood group barrier to become an alternative to ABO compatible transplantation for those with end stage renal disease facing long waiting times. This problem has been overcome by using a highly selective procedure to remove the potentially damaging blood group antibodies and slow their production during the critical post operative period. This is achieved by removing the anti-A or Anti B from the recipient using antigen-specific immune adsorption by performing several sessions of plasmapheresis. No other beneficial substances present in the plasma are removed and no plasma substitution is made either. This procedure is supported by a protocol of pharmacological drug based immune suppression and the ABO incompatible kidney transplant is performed.
The Glycosorb ABO immunoadsorption column contains ABO blood group antigens covalently bound to sepharose particles. The column is used to deplete anti-A or Anti-B from plasma. Plasma is separated from whole blood in the Apheresis system, processed through the column before it is reinfused. The reinfused plasma is depleted only of the anti-A/B but not the other proteins like the coagulation factors or other antibodies in blood. More than 2000 ABO incompatible kidney transplants have been performed worldwide without any serious side effects using the Column Adsorption technology.
Our first case
A 52-year old male, a case of Diabetic Nephropathy and advanced chronic Kidney Disease was on regular dialysis. Live related renal transplant was performed but had graft loss due to Renal Artery thrombosis and underwent graft nephrectomy. ABO-incompatible re-transplant (donor-Brother) was planned due to non availability of ABO compatible kidney. Recipient was O Positive and donor A Positive.
Patient underwent column adsorption plasmapheresis pre-operatively to reduce the Anti-A titer from 1:256 to 1:4 .This is the first time immunoadsorption therapy was instituted in our country using plasmapheresis. He received the kidney from his brother and had a fairly smooth post operative period in the hospital and was discharged on the 11th post operative day. He had normal kidney function and good urine output. One month after the surgery his kidney functions normally and urine output is good. Patient is back at work 3 months after his surgery.