Patients with chronic renal failure or end stage renal disease, who are advised Renal transplant would normally require a matched donor. About 30% of potential donors may be found to have incompatible blood groups which means that the antibodies in the patient would reject the kidney of such a donor. With the advent of new techniques, ABO-incompatible (ABOi) transplantation is now possible that permits use of available organs regardless of ABO blood type.
PROCEDURE
Immunosuppression or desensitization protocol is followed at all centres with minor variations. It mostly include a combination of pretransplant plasmapheresis or antigen-specific immunoadsorption, intravenous immunoglobulin, and tacrolimus-mycophenolate-based immunosuppression with antibody induction. Splenectomy or rituximab administration is used selectively. When the recipient's antibodies against the donor's blood type have dropped to very low levels, the transplant can take place. After transplant, a very close monitoring of the anti-ABO antibody titer is carried out for a minimum of two weeks. If necessary, plasmapheresis is added to eliminate the rebounding antibody level.
DURATION
The renal transplant is carried out as for compatible transplant, once the desensitization protocol is complete. The operation may take three to four hours. Total hospital stay may be of three weeks.
RECOVERY
Some pain and discomfort in the area of surgery is commonly experienced, which is controlled by medication. There could be numbness, caused by severed nerves, near the incision.
Recipient is given immunosuppressants to prevent the body immune system from rejecting the new kidney. The transplanted kidney may start functioning immediately or may take few weeks to function normally.
RISKS
As with any other surgery, there is risk of bleeding, infection, etc.
The recipient is more prone to infections as the body immunity is suppressed, so due care has to be taken. There is risk of rejection of the new kidney as the body considers it to be a foreign object. It may occur soon after transplantation, or several months or years after the procedure has taken place.