Kidney Transplantation – A New Age

There have been great advances in the management of kidney disease in the last five decades, and patients now live longer and with markedly improved quality of life than ever before. These changes have been made possible by an improvement in our understanding of renal disease, and in the great strides made in the fields of pharmacology and immunology.

Dialysis in various forms allows kidney patients to live near-normal lives, and a kidney transplant makes possible complete rehabilitation. A kidney transplant is therefore the choice of renal replacement therapy we offer to our patients with advanced kidney disease.

The obstacles we routinely face when counselling patients for a kidney transplant is the non availability of an organ donor. In the absence of a deceased donor (organ donation from a person who has died) a patient has no option but to look to a near relative for an organ donation.  But what if the donor (assuming you find one in your family), has an incompatible blood group?

Over the last few years we have started doing kidney transplants across blood groups, that is, we have transplanted a kidney from a donor to a recipient both of whom have different blood groups. Recent advances in technology and immunosuppressive drugs that prevent your body from rejecting a transplanted organ, have now made blood group-incompatible transplantation possible. To put it simply, now a person suffering from kidney disease can take an organ from a person who is of a different blood group than her/him – an option that wasn’t available a few years ago. These transplants have the same level of success as blood group-compatible transplants.

Over the last year and a half we have done six such transplants with complete success. One of these patients was a 65-years-old man (blood group O) who had been suffering from kidney disease for more than a year. He was getting progressively weaker on dialysis at Bareilly and decided to go in for a kidney transplant. The only problem was that in India a living organ donor can only be someone who is a near relative. All his siblings had diabetes, and his son’s blood group did not match. We explained to the patient that a transplant across blood groups is now possible and donating a kidney would have no long term impact on his son’s health.

His son was very keen on donating a kidney, and so after a detailed discussion with the family, we started the patient on Plasmapheresis. Plasmapheresis is a process by which you remove the plasma portion of the blood where the antibodies are located.

Antibodies in a person’s blood is their body’s defence against infectious organisms and other invaders. Through a series of steps called the immune response, the immune system attacks organisms and substances that invade body systems and cause disease. In the case of an organ transplant, his antibodies may view the transplanted organ as an invader and try to defend his body from it by attacking the transplanted organ.

After two weeks the patient’s antibody titres had decreased to 1:8 and he was taken for a transplant with his son as the donor. Post-operatively he did well and his kidney functioned normally throughout his hospital stay. The patient has been doing well for more than a year post transplant and so is his son. This has been our experience for the last two years with ABO incompatible transplants, and it is now an alternative for patients who have no compatible blood group donors in the family. It offers a ray of hope to people who would otherwise be on long term dialysis or worse.

The drawback in this surgery is the cost. While the cost of an ABO-compatible transplant ranges between Rs. 1.5 lakh to Rs. 7 lakh in various hospitals across India, an ABO-incompatible transplant can be up to three times as much.

Despite all the gains made in the field of transplant and immunosuppressive medication, our aim still should remain to prevent chronic kidney disease. Around 10 percent of the world’s population suffers from Chronic Kidney Diseases, and those who are above the age of 75 have almost a 50% chance of getting some form of kidney diseases.

The endeavour of all people engaged in renal care should be to educate and inform people of the various risk factors for kidney disease. We have to ensure that patients with diabetes and high blood pressure are regularly monitored and advised to keep their sugars and blood pressure under strict control. They should also be checked periodically for kidney involvement. Protein in the urine is the earliest marker of kidney involvement and allows us to intervene at a time when effective treatment is possible and kidney disease preventable. Similarly the use of over-the-counter pain medications can do harm to the kidneys and their inappropriate use should be discouraged.

The only way this growing epidemic of kidney disease can be managed is by spreading awareness about kidney disease and its causes, and ensuring that screening programmes are devised and implemented in the healthcare system. Moreover the government should give a massive boost to the deceased organ donation programme in the country so that organs are made available by deceased donors. That way no healthy individual would have to give up an organ to see their loved one live.