ABO-Incompatible Kidney Transplant in Delhi, India

A patient is diagnosed with end-stage kidney disease when their GFR falls below 15. Patients who are also positive for the following medical conditions are ideal for receiving a kidney transplant:

1. Diabetes mellitus
2. Tubular and interstitial diseases
3. Congenital, rare familial, and metabolic disorders
4. Glomerular disease
5. Renovascular and other vascular diseases
6. Retransplant/graft failure

Pediatric indications include:

1. Symptoms of uremia which are not responsive to standard medical therapies
2. Failure to thrive due to limitations in total caloric intake
3. Hypervolemia
4. Metabolic bone disease that occurs due to renal osteodystrophy and does not respond to therapies
5. Delayed psychomotor development
6. Hyperkalemia

1. Absolute contraindications for adults and children are:
2. Advanced cardiopulmonary disease
3. Major psychiatric ailments
4. Active substance abuse that cannot be successfully managed after the transplant procedure
5. Severe neurologic deficits
6. Chronic active infection with Hepatitis B
7. Severe failure of multiple organs before the transplant
8. Active malignancy, except skin cancer
9. Severe local or systemic infection
10. Active substance addiction/abuse
11. HIV infection with viral load present

Relative Contraindications include:

1. Multiple urinary tract reconstructions
2. BMI 40 - 45 or obesity
3. Lack of social support
4. Severe malnutrition/cachexia
5. Evidence of significant non-adherence
6. Age greater than 75 years
7. Advanced cardiopulmonary disease
8. Cardiopulmonary disease
9. Age less than two years or weight less than 10 kg

Patients at a high risk of developing complications that are considered on a case-by-case basis include:

1. Hepatitis
2. Neurogenic bladder
3. Ileal loop
4. Complex genitourinary anomalies
5. Peripheral vascular disease
6. HIV – (adult only under strict protocol)
7. Multivisceral transplant
8. BMI greater than 35

With ABO Incompatible Kidney Transplant, the patient is given medical therapy to prevent rejection before and after the transplant. Medical therapy lowers the levels of antibodies in the recipient's body and lowers the risk of rejection.

The medical therapy to prevent the rejection of kidneys includes:

1. Removal of antibodies from the blood, a procedure known as plasmapheresis
2. Injection of antibodies into the body that protects the recipient from infections - intravenous immunoglobulin injections
3. Injecting other medicines that protect the new kidney from antibodies

During the procedure, patients are anaesthetized with general anaesthesia and sedation. Next, the donor is prepared for kidney removal and the recipient. Once the recipient's bed is ready, the donor's kidney is placed in the recipient's body, and the incisions are closed with sutures or staples. Next, both are sent to the recovery room. Once the vitals are stable, the donor is sent to a regular room. On the other hand, the recipient is kept in isolation in the ICU or regular room.

Medicines are given to help with pain, and exercises are to be practised to prevent pneumonia. Moreover, getting out of bed needs to be practised several times a day to promote blood circulation in the legs. The first meal served is clear liquids to prevent nausea and vomiting from the anaesthesia. Eventually, the meal is adjusted based on the patient's tolerance level.

The surgery takes a mental toll on the recipient due to the isolation period, steroids, and immunosuppressants. Hence, it is essential to get counselled by a specialist before the surgical procedure. The pateint need to follow the following instructions-

1. The doctor gives the post-operative instructions to follow. A consent form for the surgery is signed at this appointment.
2. Before the operation, the doctor stops certain medications such as blood thinners and NSAIDs.
3. Avoid smoking and drinking since they interfere with the surgical procedure.
4. Jewelry, metallic objects, or any other objects that may interfere with the surgery are removed.
5. Empty the bladder before the procedure.
6. Follow fasting for 12 to 8 hours before the surgery to avoid the side effects of anaesthesia.
7. Patients are often admitted a day prior to assess vitals and inject pre-operative medicines such as antihypertensives, antibiotics, and others.

Patients with kidney transplants are at high risk and require isolation from people to avoid getting infected. Certain complications are treatable, while others may pose a threat to life. Some complications and risks associated with the kidney transplant surgery include:

1. Rejection of the transplanted kidney

   The recipient's body may not accept the newly transplanted kidney due to various reasons. Some reasons include inadequate or failed immunosuppression, missed doses of immunosuppressants, failed or compromised isolation after the surgery, infections, and more.

2. Infections

   If proper care is not taken, the recipient may easily catch infections. This may result from cold, cough, seasonal flu, repetitive pus formation, improper wound healing, injuries, and more. 

3. Surgical complications

   Surgical complications may cause delayed wound healing, delayed graft function, vascular thrombosis and stenosis, urinary leakage, ureteral obstruction, lymphocele, and in severe cases, even death.

The long-term success of a ABO-incompatible Kidney Transplant depends on how well the patient manages their condition after the surgery. It is thus advised to follow strict protocols as instructed by the doctor.

1. Regularly visit the transplant team and contact them in case of any inconveniences.
2. Take anti-rejection medicines regularly and on time and as directed by the doctor. This will keep the body from rejecting the new kidney.
3. Follow the recommended lab tests and clinic visits schedule to ensure that the kidney is functioning well.
4. Follow a healthy lifestyle and make changes in the diet, exercise routine, and weight loss if required.

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