Jaslok Hospital and Research Centre, a leading multi-specialty hospital in Mumbai, is the pioneer of Kidney and Liver transplant in western India. A recent study helmed by Dr Madan Bahadur, Director, Department of Nephrology and Kidney Transplantation, highlights a first-in-the-world medical report, that discovered life threatening side effects with certain antivirals, in patients with a genetic defect, prevalent in a subgroup of Indian transplant patients.

Valganciclovir is commonly given after kidney transplant to prevent viral infection. Patients with NUDT15 enzyme deficiency develop severely low blood counts after valganciclovir, making them prone to life threatening infections as per Dr Ashay Shingare, Consultant Nephrologist at Jaslok Hospital. A genetic test revealed NUDT15 deficiency in one recent kidney transplant recipient and after stopping valganciclovir, his blood counts improved and infection resolved.

This first case report of association between valganciclovir and genetic variation has been published in the prestigious transplant journal ‘Transplant Infectious Disease’. This genetic association report was also life-saving in case of 34-year-old Mahima Ralli, who was admitted to ICU in January 2022 with urinary tract infection after kidney transplant.

In 2002, Mahima was detected to have kidney disease followed by hemodialysis in 2004. She was admitted in ICU at Jaslok Hospital after witnessing severe rise in her blood pressure that could not be controlled, despite 7 BP medications and removal of both her diseased kidneys. She received a combination of sodium nitroprusside and sildenafil—which was a novel, first-in-the-world intervention—for control of blood pressure, which saved her life.

Later in 2004, she underwent a living donor kidney transplant with her mother as donor, which continued to function well for more than 16 years. However, due to problems in the urinary bladder, her kidney function decreased and she had to be back on dialysis in 2021. In November 2021, her maternal aunt donated her kidney to Mahima, for a second kidney transplant at Jaslok Hospital.

Prior to the transplant, a new urinary bladder was created surgically. She underwent plasmapheresis procedures as the blood groups of donor and recipient did not match. In the second month after the transplant, she developed very low blood count leading to bacterial infection that required admission in ICU.

A genotype study revealed that Mahima also had deficiency of the enzyme NUDT15. After discontinuation of the antiviral she showed improvement and was discharged from the hospital. It is a marvel that this young girl survived twice at Jaslok Hospital, receiving novel first-in-the-world medical interventions.