Bengaluru-based hospital performs pediatric kidney transplant through donor swap between two families

A city-based private hospital has successfully carried out a pediatric ABO (A, B, AB and O blood group)-incompatible kidney transplant by enabling a two-way kidney donor swap and paired exchange between two families. 

Doctors at Aster CMI Hospital, where the transplant surgery was done, claimed that it is the first paediatric swap transplant in India. A 15-year-old boy and a 21-year-old adult male, whose family donors had incompatible blood groups, underwent life-saving kidney transplants. Doctors carried out the complex procedure using the Alliance for Paired Donation (APKD) software to identify successful donor-recipient combinations.

Blood-group mismatch

Both young patients had relatives willing to donate a kidney, but neither donor could safely give the organ directly because of a blood-group mismatch. The hospital used a kidney swap supported by matching software, so the two donors exchanged recipients, enabling both patients to receive a more compatible kidney.

Kidney-paired donation (KPD) is specifically designed to overcome ABO blood-group and human leukocyte antigen (HLA) incompatibility in living donation. In this case, the teenager received a kidney from the 21-year-old’s family donor and vice versa.

By using matching technology, the hospital could assess multiple donor-recipient pairs simultaneously to identify the best compatible combinations for potential exchange. This method brings down the possibility of re-transplants for each patient and reduces the chances of infection afterwards. Crucially, this enables a safer return to normal life for both patients post-transplant. The hospital estimates that this also cuts costs by 40% compared to conventional methods.

Months of planning 

The kidney swap posed significant logistical challenges and required months of planning and coordination. The procedure involves four operating theatres (OTs) functioning simultaneously, with four anaesthetists and four transplant surgical teams, supported by infectious disease teams.

Arun Kumar N., Senior Consultant, Nephrology and Renal Transplant, at the hospital said it is time India shifts from the conventional transplant method to ABO-incompatible kidney transplants to ensure the best possible outcomes from the first attempt.

“This is a precision and target-driven transplant, assuring 99% adaptability. This gives a better perspective on survival, longer graft survival and does away with repeated transplants. The software helped us identify appropriate matches, while the coordinated efforts of our multidisciplinary teams enabled us to successfully conduct simultaneous procedures,” he said.

Avinash T.S., Lead Consultant, Urology, at the hospital, said both patients had willing family donors, but a direct transplant was not possible because of blood group incompatibility. Kidney-paired donation provided the pathway by allowing the donors to exchange recipients.