Question 1

How do you manage kidney transplants in patients with HIV, or whose immunity is already compromised?

Dr. Yajvender Pratap Singh Rana · Accepted Answer

These patients do fairly well. CD4 count is checked and optimised before travel, with good medical management started well ahead of transplant so patients only travel once they fall into a suitable category. The immediate transplant risk in HIV-positive patients is similar to other patients, though later opportunistic-infection-related complications run somewhat higher, so immunosuppression is adjusted accordingly, for example avoiding routine ATG in favour of a gentler induction agent so immunity is not suppressed as heavily.

Question 2

Is it possible for you to shed more light on blood group-incompatible transplants? I keep reading the news that these are being done.

Dr. Yajvender Pratap Singh Rana · Accepted Answer

Yes, blood group-incompatible transplants are done routinely, though they remain the second choice after a compatible donor. The recipient's antibody titre against the donor's blood group determines eligibility: titres up to 1:8 are essentially as good as a compatible transplant, and even up to 1:64 respond to one or two sessions of plasmapheresis. Higher titres, above 1:128, need immunoadsorption column filtration to bring the level down before proceeding. The success rate is good but runs slightly below a fully compatible transplant, with roughly one in 50 patients experiencing hyperacute rejection.

Question 3

Can we risk a transplant even when the HLA match, for both donor and recipient, is low?

Dr. Yajvender Pratap Singh Rana · Accepted Answer

Yes, HLA incompatibility alone is not a major problem, even between spouses with no HLA match at all. What actually determines eligibility is the cross match: a negative CDC and flow cross match clears the way for transplant. If CDC is negative but flow is positive, donor-specific antibody testing by the single antigen bead method quantifies the real risk, an MFI reading up to roughly 1,500-2,000 is not a concern, while higher readings call for plasmapheresis first. The key requirement is simply that there should be no antibodies against that particular HLA antigen.

Question 4

How do you get a compatible cadaveric kidney donation for transplant, and what is the timing involved?

Dr. Yajvender Pratap Singh Rana · Accepted Answer

Whenever a brain-dead donor is identified anywhere in Delhi NCR, India's national organ transplant authority (NOTTO) is notified and coordinates two brain stem death declarations roughly two hours apart, made jointly by the primary caregiver and a neurointensivist or equivalent specialist. Once the family consents, NOTTO allocates the organ from its waiting list strictly by turn order across hospitals, no single centre can claim it outside that process. From the first declaration to organ harvest is roughly a 12-hour process, with the recipient's dialysis and cross-match run in parallel so the transplant can proceed within six to twelve hours of harvest.

Question 5

What can be done for cases of transplant rejection where the antibody attacks the new kidney?

Dr. Yajvender Pratap Singh Rana · Accepted Answer

This is antibody-mediated rejection (AMR), one of two categories of acute rejection alongside cell-mediated rejection (ACR), and a kidney biopsy is needed to tell them apart. Treatment usually starts with methylprednisolone pulses, escalating to anti-thymocyte globulin or plasmapheresis if that isn't enough. In over a decade, hyperacute rejection has not been seen in blood-compatible transplants at this centre, and most rejection today is reversible when caught and treated promptly, the real danger comes from delayed treatment, not from the rejection episode itself.

Question 6

How does one ethically navigate finding a living donor without pressuring family or friends?

Dr. Yajvender Pratap Singh Rana · Accepted Answer

Donation has to come from love and compassion, never pressure. What actually works is reframing donation as a chance for the donor to become healthier: the thorough medical workup required for donor clearance means any underlying problem gets caught and treated, so donors go on to outlive their peer group rather than being harmed by donating. Where genuine pressure would otherwise be needed, keeping the recipient on dialysis while continuing to look for a willing donor is the ethical path, alongside broader deceased-donor campaigns to reduce reliance on living donors altogether.

Question 7

Looking to the future, is there a possibility that xenotransplantation, using animal kidneys such as from a sheep, could work in humans?

Dr. Yajvender Pratap Singh Rana · Accepted Answer

It is being tried, but the outlook is not promising because of tissue rejection and the risk of transmitting animal viruses, including parvovirus, into the recipient, so the success of xenotransplantation is still genuinely questionable. Far more promising is tissue-engineered, artificially grown organs: a related technique already in use is tissue-engineered buccal mucosa grafting for urethral stricture, where a small piece of cheek tissue is cultured in a lab and implanted into the urethra, a real, working example of the technology-biology merger that is likely to define the field's near future.

Question 8

What is the cost of kidney transplant, what are the criteria for donor selection, and at what stage of kidney failure do you advise transplant?

Dr. Yajvender Pratap Singh Rana · Accepted Answer

A routine mini-incision laparoscopic transplant package costs approximately USD 13,000-14,000, with an additional USD 3,000 for a fully robotic transplant. Donor selection starts with a related donor within the immediate family, confirmed by DNA testing, with extended family only considered if no closer relative is eligible, alongside blood-group and basic health workup. Transplant is generally advised once creatinine exceeds 7, with signs of fluid overload or hyperkalaemia, shrunken kidneys with reduced urine output, and a raised PTH indicating the kidneys will not recover, with an practical age ceiling of around 80 depending on the patient's actual physiological fitness.

Advances in Urology, Uro-Oncology and Kidney Transplant

Questions Doctors Asked Dr. Yajvender Pratap Singh Rana