Mumbai doctors perform first domino kidney transplant of the year for sensitised patients

A domino transplant involves a chain of donors and recipients where each donor matches a different recipient, creating a life-saving chain. Image for representational purpose only. Photo Courtesy: istock

Mumbai doctors have successfully performed the city's first HLA compatible, acceptable mismatch domino kidney transplant of the year. This extraordinary procedure involved six surgeries across hospitals and states, uniting three donors and three recipient families in a synchronised chain to save lives.

In a landmark medical feat, a multidisciplinary team led by Dr. Bharat Shah, Dr. Shruti Tapiawala, Dr. Pradeep Rao, Dr. Jitendra Jagtap at Gleneagles Hospital, Parel, Mumbai. Leveraging advanced transplant immunodiagnositics and acceptable mismatch techniques in HLA medicine, the domino transplant addressed the unique challenges of highly sensitised patients which is only 7-10 per cent of transplant population, marking a new milestone in renal transplantation for our state and country.

Dr. Bharat Shah, director of renal science at Gleneagles Hospital, remarked, "This achievement exemplifies the power of teamwork, precision, and innovation in modern medicine. With domino transplants, we are creating a life-saving ripple effect for patients who once had no options. It is a privilege to lead such groundbreaking efforts that transform lives."

Dr. Shruti Tapiawala, consultant nephrologist, highlighted, "Sensitised patients, often due to prior transplants, pregnancies, or blood transfusions, face immense difficulties finding compatible donors. With the help of advanced transplant immunodiagnositics and acceptable mismatch techniques in HLA medicine, the domino transplant addressed the unique challenges of highly sensitized patients which is 7-10 per cent of our population seeking transplants are highly sensitised, with antibodies increasing their risk of rejection to 30-35 per cent even with desensitisation protocols.

A domino transplant involves a chain of donors and recipients where each donor matches a different recipient, creating a life-saving chain. The procedure was essential for patients battling kidney failure and inability to get transplanted due to high risk of rejection with their available family donors.

1. A 55-year-old lady from Hyderabad, with multiple donor-specific antibodies against multiple family donors, due to which she faced rejection risks from all her relatives, including her brother, aunt, husband, and maternal uncle.

2. A 17-year-old boy, whose first transplant failed during the COVID-19 pandemic, required specialised care to overcome sensitisation from his earlier transplant and antibodies against his aunt and father precluding him from receivinga kidney from them.

3. An 18-year-old girl, previously lost a kidney due to infection and faced additional challenges due to congenital abnormalities and HLA antibodies against her mother who was her potential kidney donor.

Months and years of waiting to find an acceptably mismatched donor with whom the rejection risk would be minimal with lesser immunosuppression and cost, rigorous HLA (Human Leukocyte Antigen) matching and antibody profiling, virtual and physical cross-matching, and extensive counseling culminated in this life-saving procedure. On December 19, three donors and three recipients underwent complex transplant surgeries lasting 18 hours.

Dr. Pradeep Rao, director of urologist & kidney transplant, explained, "Kidney transplants for sensitised patients often require solutions beyond traditional donor-patient matching. Paired exchange or domino transplants, though legally and logistically challenging in India, are game-changers for such cases. Without these options, many patients would remain on dialysis indefinitely."

A life-saving journey
One of the grateful recipients, a patient from Hyderabad, shared, "After years of waiting and failed attempts, I feel healthy and hopeful again. This would not have been possible without the expertise of Dr. Shruti Tapiawala and my nephrologist, Dr Anuradha, who collaborated to make this miracle a reality. I am immensely thankful to the donor for their selfless act."

Dr Bipin Chevale, CEO of Gleneagles Hospitals, Parel, Mumbai, concluded, "This successful domino transplant is a testament to our hospital's commitment to pushing boundaries in medical science. We are proud to be at the forefront, providing hope and healing to patients who had limited options."