Kidney Swap Transplants: Turning Two Incompatible Pairs Into Two Successful Ones

The initial 6 months are very crucial. During this time they need to check their drug levels, maintain extreme hygiene, and creatinine can go up and down. Drug toxicity, infection and rejection risks are all high in this window, so they need to stay in touch with their referring physician and keep us in the loop as well. Beyond 6 months they don't need to visit as frequently, but immunosuppression is lifelong. The two medications that remain long-term are tacrolimus and mycophenolate mofetil.

The difference between open and robotic kidney transplant is just around USD 3,000. But if somebody catches a serious infection in an open transplant, the hospital expenses for that alone may be more than USD 10,000. The serious infection risk in robotic kidney transplant is approximately 1 percent compared to approximately 10 percent in open kidney transplant. If you do the economics properly, robotic kidney transplant is actually the cheaper option over the full course of care.

The size of the vessels matters, whether it is open surgery or robotic surgery. If a vessel is less than 1mm, joining these small tiny vessels is of course difficult. If they are in the upper pole of the kidney, we can always sacrifice them. But if they are in the lower pole, they supply the ureter, so we cannot skip those. The best approach, if you have the slightest doubt you won't be able to handle multiple vessels, is to join them together on the bench while the kidney is in ice, then join a single bigger lumen during the transplant.

If there is a rejection in an unmatched transplant, we treat it exactly the same way as a compatible transplant. The first thing to check is the trend of creatinine and urine output. Then biopsy, which is the gold standard test. Once biopsy confirms it, the first line of treatment is pulse therapy, high-dose steroids. If the response isn't good, we go to second-line treatment: rituximab or plasmapheresis to filter out the preformed antibodies.

The real chance of having rejection despite all the testing is even 1 to 2 percent, and even then the medicines are strong enough to save those kidneys. For ABO-incompatible transplant, the rejection chance is 5 to 10 percent, and it's sometimes more difficult to save those kidneys, but even at a 10 percent rejection chance, 8 out of 10 patients can still survive with a functioning kidney after anti-rejection therapy.

The transplant centre looks for another couple with the reciprocal mismatch, for example a couple needing blood group A with a blood group B donor. Each donor gives to the other couple's recipient instead of their own.

Yes. Dr. Ahmad has coordinated three to four international swap transplants, where a nephrologist in the referring country identifies the pairing, confirms compatibility, and arranges for each donor to give to the other family's recipient.

A couple is left choosing between an ABO-incompatible transplant, with its higher rejection risk, or continuing on dialysis while waiting for a compatible option.