At PGI, Pair B donor to Pair A recipient and vice-versa

The department of nephrology along with the department of urology and renal transplantation performed the transplant PROFESSOR NARAYAN PRASAD, head of department, nephrology

LUCKNOW : The Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS) has performed the first ‘swap kidney transplant’ in the state.

The department of nephrology along with the department of urology and renal transplantation performed the transplant on Tuesday, said head of department, nephrology, Professor Narayan Prasad.

“Swap kidney transplant is also known as paired kidney exchange. In this, if there are two sets of donors and recipients and tests show that in both cases, the recipient’s body will not ‘accept’ the donor’s organ, a swap takes place and the recipient of Pair A gets the organ from the Pair B donor, while Pair B recipient gets the kidney from Pair A donor,” he said.

The doctors at PGI have done a two-way swap transplant between two incompatible pairs, with two live donor transplants simultaneously. The swap donation was made legal with the Tissue and Human Organ Transplantation Act, Amendment and Rule of 2014.

Case I

A 53-year-old resident of Azamgarh, was diagnosed with end-stage renal disease, when she contacted Prof Narayan Prasad at the OPD in 2018. She has been on dialysis since then. Her 54-year-old husband came forward to donate his kidney to his wife. Dr Prasad performed detailed immunological matching. However, on immunological matching, she had multiple high-strength antibodies (donor specific antibodies, DSA) against her husband’s kidney.

The cross-match test turned out to be positive, a situation which is a contraindication for transplant, and renal transplant, if performed, would 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 donors in the family.

Case II

Another 47-year-old patient, a resident of Lucknow, has been on dialysis since 2019. His 40-year-old wife willingly came forward as a kidney donor. Unfortunately, in this case the patient also had very high strength DSA against her wife’s kidney on immunological matching. He had a strong cross-match positive report and hence the donor was not suitable to donate a kidney to her husband.

These matchings are done at few public sector institutes, and this single antigen bead test is done in the renal lab of SGPGIMS.

The Swap

The nephrology team thought of alternative ways to do the transplant and discussed with the urology team and a decision to go ahead with swap renal transplant was taken.

Another cross-match test after swapping the above two donors (Mrs. C with Mrs. S, and Mr. R with Mr. J) was performed which came 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 permis

sion was obtained for swap transplant from the hospitalbased authorization committee.

The committee permitted this swap transplant as per human Organ Transplant Act. 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 transplant. He was assisted by the team consisting of Dr. Ansari, Dr. Uday Pratap Singh and Dr. Sanjay Sureka .

Professor Narayan Prasad said, “The paired donation has several advantages. It is cost effective, does not require any desensitisation techniques and the recipients have to take fewer immune-suppressants. The waiting period is significantly reduced with a better graft and patient survival rates. The success rate of this better matched transplant is always better than a transplant after desensitisation.”