However, this long established rule may be a complication of the past. On March 8, 2007, Dr. Sandip Kapur, transplant surgeon at NewYork-Presbyterian/Weill Cornell and associate professor of surgery in transplantation at Weill Cornell Medical College, performed a successful kidney transplant on Ronald (blood type O), who has a conflicting blood type with his donor, his wife, Sandra (blood type B).
This type of transplant surgery has been named ABO Incompatible Transplantation, because it allows surgeons to carry out transplant surgeries between two people of conflicting blood types.
"Six or seven years ago this transplant would have been impossible to do," says Dr. Kapur. "We are now seeing very similar success rates between patients who receive this procedure, and those who have more traditional transplants."
Blood type is determined by the absence or presence of a particular antigen – compounds found on the surface of each red blood cell. There are three significant red blood cell antigens – A antigen, B antigen, and RhD (Rhesus D) antigen.
People with blood type A have A-antigens, B-people have B-antigens, AB have both A and B-antigens, and blood type O have no antigens present on their red blood cells' surface. Those with type O can donate blood to individuals of any ABO blood group for transfusion. Blood types that are A-positive have the presence of RhD antigen – negative stands for the absence of the RhD antigen.
When a foreign blood type is introduced into the circulatory system, the body creates antibodies that bind to the unfamiliar antigen and signals the immune system to wipe out the invader. Sometimes this reaction will only destroy the alien blood cells, but it may commonly cause massive native red blood cell destruction, leading to low blood pressure and even death.
To prevent such a reaction during Ronald's kidney transplant surgery, Dr. Kapur, in collaboration with Dr. Darshana Dadhania, assistant professor of medicine and assistant attending physician-surgeon at NewYork-Presbyterian/Weill Cornell, and with colleagues at the Immunogenetics and Transplantation Center of The Rogosin Institute, treated Ronald prior to surgery, reducing the existing red blood cell antibodies and the potential to make new antibodies.
An ideal candidate for ABO Incompatible Transplantation Surgery must have an antibody level in their body that is reasonable for manipulation, says Dr. Dadhania. If there is a high titer – antibody level – it is more difficult to lower the antibodies in the recipient's body.
"The patient goes through two separate procedures to reduce the existing antibody-level, which allows us to transplant the organ and disarm the patient's immune system," says Dr. Dadhania.
First, Ronald, the organ recipient, had immune drug therapy, similar to the regimen that a normal donor-recipient undergoes, so that his body would not reject his wife's donor-kidney. Second, Ronald underwent plasmapheresis, a procedure that uses a machine to wash and leech out antibodies from the blood plasma and then returns it to the patient's body.
"These steps allow for accommodation of the organ for long-term function in the recipient's body," says Dr. Dadhania.
Dr. Manikkam Suthanthiran, the Stanton Griffis Distinguished Professor of Medicine and chief of Nephrology and Transplantation Medicine at Weill Cornell, devised the treatment protocol that made the transplantation of the previously incompatible kidney possible.
Ronald is currently undergoing the same standard drug therapy that any other transplant patient receives. A recent biopsy has shown that his donor kidney shows no sign of rejection by his body.
For interviews with patients and doctors, members of the press may contact the Office of Public Affairs at (212) 821-0560.
For media inquiries please contact Andrew Klein at 212-821-0560 or ank2017@med.cornell.edu
