KIMS hospital Kurnool- pioneer in transplant program in Rayalaseema region

Details shared by Dr K Anantha Rao, Nephrologist, KIMS Hospital, Kurnool.

Kidney transplant is the best option in patients suffering from kidney failure. There are mainly two kinds of kidney donors – Living and Cadaver. Living donor can be blood group compatible or incompatible. Doing ABO incompatible transplant is technically more difficult, more costly and outcomes are slightly inferior to blood group matched donor. About 1.8 Lakh people are waiting for kidney transplant in India, out of which 30% die every year. Only 6000 transplants are done per year.

Cadaveric transplant program waiting period is about 3 to 4 years. In order to expand the donor pool, and to reduce the treatment cost, swap transplant can be done which is permitted by law in India. In swap transplant, donor of first recipient donates to second patient and vice versa.

Sl.No.      Recipient   Donor

1              A+ve           B+ve

2              B+Ve             A+ve

Swap transplant can be within a hospital, between two hospitals in a city, between two cities, or between two states. THOA (Transplanatation of human organs) act 1994 does not allow organ donation by unrelated person, but 2011 amendment of the act allows an unrelated donor to donate his kidney to a recipient whose family member would in return donate one kidney to another patient. Swap transplant id useful in blood group incompatibility, HLA incompatibility, donor with HBV or HCV infection. Swap transplant outcomes are better than ABO incompatible and cadaveric transplants.

KIMS Hospital Kurnool has done first swap transplant on 30/1/24, which is also first of its kind in Rayalaseema region. The first pair, recipient Mr Daiva Prasad, blood group A+ve, who is working as a DSP in Kurnool, was detected to have kidney failure one year back, but transplant was not done as wife was of different  blood group, B+ve. Option of swap transplant was told to him and he waited till he got a blood group matched donor. Second patient Mr Venkata Kondiah, blood group B+ve, was initiated on dialysis 6 months back. He initially proposed his wife as a donor for transplant; workup revealed wife was unfit for donation. Subsequently he proposed his mother as a donor who was A+ve blood group. Hence, in view of blood group mismatch, option of swap transplant was discussed with both pairs, for which both were willing.

Compatibility between the pairs was tested. . Authorization committee meeting was done at KIMS hospital, later, it was sent to state authorization committee for approval.  Mr Daiva Prasad’s wife donated kidney to Mr Venkata Kondiah, where as Mr Venkata Kondiah’s mother donated kidney to Mr Daiva Prasad. Compared to a related donor, swap transplant is difficult, as four surgeries have to be started simultaneously. This requires more operation theatres, more number of surgeons, OT staff, and adequate beds in kidney transplant unit. All these facilities are available in KIMS hospital Kurnool. This required coordinated work of Nephrology, urology/ transplant surgeon, anaesthesia, OT staff and KTU staff.  About 20 health care staff worked in coordination for 12 hours on the day of transplant. The transplants have been successful and both patients and donors were discharged with stable kidney function.

The team included Nephrologist- Dr Anantha Rao, Dr Suresh, transplant surgeons- Dr Uma Maheshwar Rao Ch, Dr Manoj kumar, Dr Durga Prasad, Anesthetists –Dr  Balasubramanyam, Dr Bhuvaneshwari, Dr Akthar, Dr Swati. This is the first of its kind in not only Kurnool, but also in Rayalaseema region. Any patient suffering from kidney failure in Rayalaseema region can consult Dr Ananth Rao (9000819193), Nephrology department KIMS Kurnool for best options, including swap, ABO incompatible or cadaveric transplant , all of which are done here. Thirty five transplants have been successfully done at KIMS Kurnool so far with excellent outcomes.