Apollo Speciality Hospitals, Madurai, has successfully performed an ABO-incompatible living-donor kidney transplantation using advanced antigen-specific immunoadsorption therapy, enabling a 40-year-old man with blood group O positive to receive a kidney from his wife, who had blood group A positive.
ABO-incompatible kidney transplantation is a complex procedure because naturally occurring antibodies in the recipient can attack the donor organ and lead to transplant rejection. In this case, the recipient had a high baseline anti-A antibody titre of 1:256, making careful antibody reduction and immunological preparation essential before transplantation.
Initially, a conventional desensitisation protocol involving approximately six sessions of plasma exchange (PLEX) was planned to reduce the antibody levels. However, following the first PLEX session, the patient developed cellulitis of the lower limbs. Considering the active infection and the associated risks of transplantation, the procedure was appropriately postponed for approximately one month, allowing the infection to be treated and adequately resolved.
Following recovery, the transplant team adopted an antigen-specific immunoadsorption strategy to selectively remove anti-A antibodies from the patient's plasma. Unlike conventional plasma exchange, which removes plasma and requires replacement with albumin and/or fresh frozen plasma, antigen-specific immunoadsorption selectively removes the targeted antibodies while returning the treated plasma to the circulation. This targeted approach helps minimise the loss of plasma proteins and coagulation factors and reduces the routine requirement for plasma replacement and there by the risk of infection associated with the procedure.
With sequential antigen-specific immunoadsorption treatments, the patient's anti-A antibody titre was successfully reduced from 1:256 to 1:8. Once the desired antibody level was achieved, the patient successfully underwent ABO-incompatible kidney transplantation from his wife.
The transplant procedure involved a coordinated multidisciplinary team comprising Lead Nephrologist Dr. Arun Prasath P, Dr. Saravanan R, Dr. Alagappan; Urologists Dr. Arun Kumar J, Dr. Shankar K, and Dr. Vishnuraja R; and CTVS Surgeon Dr. Sridhar V, along with experienced Anaesthesiologists Dr.Rikesh & Dr.Vasanth, Intensivist Dr.Ayappan, transplant nursing, and critical care teams.
Dr. Arun Prasath P, Consultant Nephrologist, said, “ABO-incompatible transplantation requires meticulous immunological preparation, particularly when the recipient has a high antibody titre. ABO-incompatible recipients have naturally occurring antibodies against the donor’s blood-group antigens, which, if present at high levels, can attack the transplanted kidney and lead to antibody-mediated rejection and compromised graft function. Therefore, desensitisation to reduce these antibodies to an acceptable level is a critical part of transplantation across an ABO barrier. In this case, antigen-specific immunoadsorption provided a targeted approach by selectively removing anti-A antibodies while returning the treated plasma to the patient. The patient’s anti-A antibody titre was successfully reduced from 1:256 to 1:8, enabling us to proceed safely with transplantation. The successful outcome demonstrates the importance of personalised desensitisation strategies, careful monitoring of antibody titres, and close assessment of the patient’s overall clinical condition, particularly in a case where conventional plasma exchange presented challenges. Immunoadsorption can offer a targeted method of antibody removal in appropriately selected patients undergoing ABO-incompatible transplantation.”
Dr. Nikhil Tiwari, Chief Executive Officer, Apollo Hospitals - ROTN, said, “This successful ABO-incompatible kidney transplant demonstrates Apollo Madurai’s commitment to bringing advanced transplant technologies and specialised clinical expertise closer to patients in South Tamil Nadu. The coordinated efforts of our nephrology, urology, CTVS, anaesthesia, intensive care, and transplant teams enabled us to overcome a significant immunological barrier.”
Dr. P. Shobana, Medical Superintendent, Apollo Speciality Hospitals, Madurai, stated, “Successful complex transplantation depends not only on advanced technology but also on robust clinical protocols, infection control, critical care, and seamless teamwork. This achievement reflects Apollo Madurai’s comprehensive approach to delivering safe and specialised transplant care.”
This successful case highlights the evolving role of antigen-specific immunoadsorption in ABO-incompatible kidney transplantation. The ability to selectively reduce anti-A antibodies from 1:256 to 1:8 enabled transplantation in a recipient who initially faced significant immunological and clinical challenges.
Apollo Speciality Hospitals, Madurai, continues to strengthen its advanced transplant services through specialised nephrology and urology expertise, modern immunoadsorption technology, multidisciplinary surgical capabilities, and advanced anaesthesia and intensive care support, helping expand access to complex living-donor kidney transplantation for patients across South Tamil Nadu.