First ever swap kidney transplant done at SGPGIMS
Health, Sanjay Gandhi Postgraduate Institute of Medical Sciences, SGPGIMS, Lucknow
Lucknow : For the first time in the Uttar Pradesh, the department of Nephrology along with the department of Urology and renal transplantation in the Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS) in Lucknow have performed the swap renal transplant, which is also known as paired kidney exchange.The transplant was performed on Tuesday.According to a SGPGIMS release, in swap renal transplantation, the donor kidney of one pair is exchanged with another one, to make it suitable for successful transplantation. The two-way swap transplant was done between two incompatible pairs, with two live donor transplants simultaneously.The swap donation was made legally permissible with Tissue and Human Organ Transplantation act, amendment and rule of 2014.According to doctors, one patient, aged 53 years, resident of Azamgarh, was diagnosed with end stage renal disease, when she came to SGPGIMS in 2018. She has been on dialysis since then.Her husband, aged 54 years, came forward to donate one kidney to his wife.The doctors carried out detailed immunological matching but it was found that the patient had multiple high strength antibodies (Donor specific antibodies, DSA) against her husband’s kidney.
The crossmatch test turned out to be positive, a situation which is a contraindication for transplantation and renal transplantation if performed, will lead to severe rejection or in other words the kidney of the husband would not be accepted by the body of the wife.She did not have any other alternate kidney donors in the family.Another patient with End-Stage Renal Disease (ESRD), aged 47 years, was on dialysis since 2019.His wife, aged 40 years, willingly came forward as a kidney donor. Unfortunately, he also had very high strength DSA against her wife’s kidney on immunological matching. He had a strong crossmatch positive report and hence the donor was not suitable to donate kidney to her husband.These matchings are done at very few public sector institutes, and this single antigen bead test is done in the renal lab of SGPGIMS.The nephrology team thought of alternative ways to get the transplantation and discussed with the urology team and a decision to go ahead with swap renal transplantation was taken.Another crossmatch test after swapping the above two donors (first patient with second donor and second patient with first donor) was performed which came as negative and there were no donor specific antibodies after swapping.
This was explained to both the pairs, and they gave their full consent for the same. Other parameters were also compatible and hence permission was obtained for swap transplant from Hospital Based Authorization committee.The transplant surgery was successfully performed under the leadership of Prof Aneesh Srivastava who is the professor of transplant surgery and Head of the department of Urology and renal transplantation.
The transplant surgery for both the pairs was executed simultaneously by the team of Prof Aneesh Srivastava.The team of nephrology, urology, and anaesthesia, acted coherently to make it a successful transplantation to provide future healthy life to these end stage renal disease patients.The kidney paired donation has several advantages. It is cost effective, does not require any desensitization techniques and the recipients have to take much lesser immunosuppression.The waiting period is significantly reduced with better graft and patient survival rates. The success rate of this better matched transplantation is always better than transplantation done after desensitization.