Is ABOi transplant an option for kidney disease patients?

March 08, 2019

Pavan (name changed), a 30-year-old auto driver from Ramanagara with chronic kidney failure was undergoing dialysis for the past three years. He was advised a kidney transplant. Pavan refused to let his younger brother donate his kidney as he was now the sole bread winner in the family.

As the father had abandoned the family and having seen his agony, Pavan’s mother decided to donate her kidney. After extensive counselling, his 55-year-old mother donated her A+ve kidney to an O+ve Pavan in an extremely rare ABO-incompatible (ABOi) transplant. Astonishingly Pavan’s antibody levels against A +ve blood group were so low that it led to a successful transplant.

The shortage of organ donors with the same blood group and rise in the incidence of the end-stage renal disease has made ABOi transplantation, despite its risks, a preferred option. This involves the recipient receiving a desensitization treatment before and after a kidney transplant to lower the antibody levels in the blood and reduce the risk of rejecting the donor’s kidney.

Desensitization is usually achieved by plasmapheresis or immunoadsorption. Dr Deepak Kumar C, Chief Consultant - Nephrologist and Transplant Physician, Columbia Asia Referral Hospitalexplained, "ABOi Kidney transplant is expensive compared to the one which is of same blood group. It is costlier because of higher antibody titers. The ABOi transplant cost depends on the anti-body titers and it varies from individual to other and is in the range anywhere between 1:4 to 1:1024. Higher the titers, more is the requirement of plasmapharesis or immunoadsorption and this is when the expense of the transplant shoots up. In the case of Pavan fortunately it was 1:4 and this is when the procedure was cost effective to him."