Pune Surgeons Successfully Transplant Kidney Despite Blood Group Mismatch and Multiple Arteries

Left to right: Mr.Rahul Mashale (Donor), Mrs Aarti Mashale ( Recipient), Dr.Saurabh Khiste – Consultant – Nephrology, Dr.Anand Dharaskar – Consultant -Urology, Dr.Tarun Jeloka- Hod & Consultant – Nephrology & Transplant, Dr. Aashish Pathak – Consultant – Anaesthesiology, Dr. Shrirang Ranade – Consultant – Cardiovascular Thoracic Surgery, Mr.Anand Mote – Cluster Director – Manipal Hospital, Pune, Dr.Chinmay Erram – Head Medical Services, Reshma Kulawade – Transplant Coordinator at Manipal Hospital, Baner, Pune.

ABO incompatibility between the donor (AB+) and the recipient (A+) increases the risk of rejection and requires special protocols to overcome

A rare case of the donor having triple renal arteries

PUNE: Despite challenges of different blood groups and multiple arteries, a 40-year-old female resident of Pune who suffered kidney failure was successfully treated by the doctors of Manipal Hospital, Baner.

Aarti Mashale, a homemaker, has been facing a series of severe health issues since 2015. Her struggles began with a diagnosis of SLE (Systemic Lupus Erythematosus) and lupus nephritis, a debilitating autoimmune disease. Despite trying five different forms of medications, her severe hypertension remained uncontrolled. In 2020, her health further deteriorated with the onset of herpes zoster and diabetes. By April 2021, she had developed early signs of kidney failure, which rapidly progressed, culminating in the need for dialysis by 2023.

As Aarti’s condition continued to deteriorate, she required an urgent kidney transplant. Her husband, Rahul Mashale (43) decided to donate one of his kidneys. However, the transplant was challenging due to ABO incompatibility (mismatched blood group), with Rahul having AB+ blood and Aarti having A+ blood. Further evaluation revealed an additional challenge that Rahul had triple renal arteries, a rare anatomy occurring in only 10% of the population. Defying all odds, Dr. Tarun Jeloka and Dr. Anand Dharaskar along with their team, successfully performed the kidney transplant on 18th July 2024.

Speaking on the case, Dr. Anand Dharasakar, Consultant Urology said, “This was a challenging case for us. Performing a transplant was complicated as the donor had three renal arteries, while the recipient had only one. Suturing the three arteries was difficult in the donor’s case, therefore, we performed a laparoscopic surgery to harvest the kidney, which is less invasive, quicker to heal, and more cosmetically preferred for the donor. However, transplanting the kidney into the recipient with only one artery was equally daunting, requiring precise vascular reconstruction to ensure proper blood flow.”

Overcoming the challenge of mismatched blood groups, Dr. Tarun Jeloka, Consultant of Nephrology and Transplant said, “We performed the transplant using a special protocol for incompatible blood types. To reduce the risk of rejection, we gave the patient a monoclonal antibody medication two weeks before the transplant, followed by additional medications a week before. We also did a procedure called plasma exchange to remove harmful antibodies from the blood until they reached a safe level. Despite the higher risks, the transplant was successful, just like a matched transplant. The patient’s kidney function became normal within two days, and was able to go home without any complications.”

The donor was discharged within 7 days, while the recipient was discharged within 9 days of the procedure. The recovery period for both will be the same as for matched transplants: 2-4 weeks for donors and 6-12 weeks for recipients. Both donor and recipient can expect to live normal lives, with the recipient required to take transplant medications lifelong.

The transplant team involved Dr. Tarun Jeloka, Dr. Anand Dharaskar, Dr. Saurabh Khiste, Dr. Shrirang Ranade, Dr. Nilesh Warwantkar, Dr. Ranjeet Maheshgauri. Anesthesia support was provided by a team headed by Dr. Ashish Pathak.

In India, as reported in 2022, 71% are female donors, and among spousal transplants, 90% are wives. Males are considered bread-earning members and hence have a concern toward non-donation. However, we want to emphasize that kidney donation does not compromise health in any way and this and similar cases should become examples for male donors.

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