Chennai, 30 July 2025: SRM Global Hospitals successfully performed a high-risk ABO-incompatible kidney transplant, a procedure involving a donor and recipient with different blood types, on a 28-year-old former IT professional who had been on dialysis for over three years after his kidneys failed due to an autoimmune condition. To minimise the risk of rejection of the transplanted kidney, which was donated by his father, the hospital employed a specialised procedure called immunoadsorption to significantly lower the patient’s antibody levels to within the standard safety threshold at the time of the transplant. The patient is now recovering well and has transitioned from dialysis to oral immunosuppressive therapy for ongoing management.
The patient, Joseph Raj, from Chennai, was diagnosed with IgA nephropathy, a chronic kidney disease in which the immune system produces antibodies that mistakenly attack the kidneys, often due to genetic factors. The disease led to end-stage renal failure, forcing him to quit his job and undergo dialysis three times a week for the past three years.
In the absence of a compatible donor, Joseph’s father, who is A positive, volunteered to donate his kidney, although Joseph’s blood group is O positive. This mismatch made it an ABO-incompatible transplant, a procedure associated with high risk due to the presence of naturally occurring antibodies in the recipient’s blood that can attack the donor kidney. These antibody levels, known as titer levels, reflect the strength of the immune response. A titer above 1:512 indicates a high concentration of antibodies, which can aggressively attack the donor kidney and increase the risk of rejection. However, the patient’s titer level was significantly high, around 1:1024.
Considering the complexity of the case, the hospital initiated a unique desensitisation protocol 14 days prior to the ABO-incompatible transplant. This included the use of immunoadsorption, a specialised procedure that selectively removes harmful antibodies from the blood. The process successfully reduced the antibody titer to a safe level of 1:8 approximately 24 hours before the surgery. The transplant was then carried out, followed by close postoperative monitoring. When antibody titers spiked again, a second immunoadsorption session was promptly administered. The patient was discharged on the eighth day in stable condition, with a normal creatinine level of 1.1—an encouraging indicator of healthy kidney function.
Post-surgery, Joseph Raj responded well to immunosuppressive therapy and was discharged in excellent spirits, marking a remarkably swift recovery period. He is currently under regular follow-up and immunosuppressant therapy. His post-surgery plan includes following a healthy lifestyle, infection control, and routine checkups. He is expected to lead a normal life and can eventually resume work.
The transplant team was headed by Dr. Mathew Gerry George, Senior Consultant Nephrologist, and Dr. Deepak, Consultant Urologist and Transplant Surgeon.
In his comments, Dr. P. Sathyanarayanan, President of SRM Global Hospitals, said, “This extraordinary case stands as a testament to the clinical excellence and speed of execution demonstrated by our transplant team. Managing such a complex protocol within a tight timeline is a matter of immense pride for us. With ABO-incompatible transplants, patients no longer have to wait for the same blood group match, as it expands the donor pool vastly. We are proud to join the list of few hospitals performing such transplants successfully and safely, promising a fresh start to the patient.”
Talking about the surgery, Dr. Mathew Gerry George, Senior Consultant Nephrologist, SRM Global Hospitals, said, “The goal of a kidney transplant is to improve the quality of life of a patient. This case is significant because we incorporated ABO-incompatible transplant, which was once considered high-risk and near-impossible beyond certain titer limits, and is now within reach with the right expertise and infrastructure. This milestone is now a convenient and reliable solution for patients with willing but non-matching donors. This development opens new avenues for kidney patients who were previously limited by blood group constraints, significantly increasing the donor pool and improving their quality of life.
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