It was in his blood that a 30 -year -old man should make history. Lellular.
In the middle of 2024, the patient performed a kidney transplant. Although he was relatively young for a transplantation, it is not the place where he is unique. He had a very rare Bombay blood group, which prevented him from obtaining organs or even blood transfusions, who did not have the same blood group through their nerves.
But then he did it exactly: His mother donated her kidney, although she did not have a Bombay blood group. Doctors at Mioot International in Chennai, who demonstrated a cross-bladow transplant close to two decades, were ready to cross Rubikon in a sector, with no prediction.
A sheer miracle
In a recent paper published in the magazine reviewed by the colleague Kidney International ReportsThe team that worked on the transplant – Rajan Ravichandran, Yashwant Raj T., and Kanakraj Arumugam, chronic for the posting of how a team of doctors pulled in Chennai, which could not have been long ago that a sheer miracle. The form was not kept down. Senior Nephrologist Dr. Ravichandran explained, “It was impossible for patients with Bombay Blood Group to get blood or organs from another blood group.”
She believes that she begins about two decades ago, when she was trained to transplant cross-bladow in Japan, when donors and recipients have different blood types, refer to implants. . In 2010, he and his team used a kidney from a donor with a donor with a donor in MIOT HOSPITles, successfully on a recipient with O blood group. Using a special procedure called Plasmapheresis (DFPP) developed by Japanese, the team had discharged the patient in a week and returned to his software job in three months time.
“The most essential requirement in transplanting is a blood group match – ideally, the patient’s own blood group, or in this event it is not available to any group for which his blood does not take antibodies,” Dr. Ravichandran explained.
Antibodies are used by the body to detect and neutralize foreign bodies, while antigens are protein or carbohydrates found on the surface of red blood cells, white blood cells and platelets, and they determine blood types. .
Bombay blood group
Bombay, aka HH, Blood Group is a rare blood group discovered by YM Bhende in 1952 in Mumbai. The major difference between Bombay Blood Group and Common ABO blood groups lies in the appearance (or absence) of H antigen, which is the fundamental building block for ABO blood group system.
In ordinary individuals, H Antigen A and B acts as the base structure for the manufacture of A and B antigen. In individuals of the Bombay blood group, the gene is mutated or absent responsible for the production of H antigens, so neither A nor B Antizen can be formed.
Therefore, these people cannot receive blood transfusions from any ABO group including type O, which has H antigen. They can only get blood from another Bombay blood group donor. Its prevalence is about 0.0004% of the total human population (one in 4 million). While it falls into one of the one lakh in the European population and one in 10,000 in Mumbai, the work of finding a donor is still difficult.
Clinical challenges
This index was also challenging for the patient. The issue was not to find a donor for a kidney: her mother was eager to donate her; The prophet was that his body would reject it outright because he had different blood groups. “We decided that it was time to use the principles of cross-bladow matching that we also use for ABO type here. We assumed that this was a similar situation and decided to use DFPP’s Japanese technology, ”Dr. Ravichandran said.
“Once you identify the Bombay blood group, you know that it has anti-H antibodies. First, we measure anti-A and anti-B antibodies in the blood as we do in the case of ABO cross-blades. Here, in addition, you will also have to measure levels for anti-H antibodies, and levels will have to be titled. The next step is to give the patient a monoclonal antibody injection to remove B cells that produce antibodies, ”he said.
As authors have expanded in paper, clinical challenges in such a scenario, even in people with rich cross-blades transplant experience in ABOs, determine a safe anti-H antibody tight cut-off It is involved, which is enough to prevent the body from rejecting. Anga from the donor.
In particular, there is no prediction for this, so someone, again, had to take a safe level of antibody concentration. Hyper-torrent is a high risk of rejection because anti-H antibodies are more powerful than anti-A or anti-B antibodies.
“After determining the title (level) of the antibodies, we started plasmapheresis, which again removes antibodies in the blood, reduces the possibility of rejection. It was combined with immunosuppressive ivig [intravenous immunoglobulin] To further suppress the antibodies, so that the hypercuts of the organ can be prevented. ,
Every alternative day, the team measured the level of antibody in the patient. “Generally for Anti-A and Anti-B, we consider the 1-in-16 concentration of antibodies to be an ideal safe point for starting transplantation. It starts from 1 -in -256, then we bring it down, reduce the present antibodies. There is just no cut in anti-H, so we made some perceptions, ”he said.
a new Hope
Which was considered a safe, no-rejection antibody titre, was performed on transplant surgery. The team scattered the state for units of Bombay Blood Group Units, just if the patient may need it during transplant surgery, as cross-bladow transfusion is not possible. However, he did not need it. The team said the surgery passed through one air and there was no complication during or later during the surgery.
While there is no published literature about the residence of anti-H antibodies by Graft, as it was not tested earlier, doctors in this patient achieved a no-rejection antibody titre status, and there was no rejection. Doctors said that the first two weeks, which are also important to decide whether the organ would be rejected, was passed without any event.
Six months later, the patient is able to resume well and re-start his pre-introduction activities, it is grateful to how it has become impossible for him-and hope, for others in Bombay blood group, for others, If they ever need transplant.
Published – February 10, 2025 03:22 am IST
