Nandyal man gets rare kidney transplant at KIMS Kurnool after desensitisation therapy

Hyderabad: In a rare medical development, a highly sensitised kidney failure patient in Nandyal, Andhra Pradesh, has successfully undergone a cadaveric kidney transplant following months of desensitisation therapy—a procedure typically reserved for live donor cases.

The case sheds new light on the challenges faced by patients with elevated antibody levels and opens the door for similar interventions in the future.

When does kidney transplantation become difficult?

Kidney transplantation becomes especially difficult when patients develop high levels of antibodies in their bloodstream, often as a result of previous blood transfusions or transplants. These antibodies, measured using the Mean Fluorescence Intensity (MFI) scale, can cause the body to reject a new organ almost immediately.

A safe threshold for transplantation is generally considered to be below 3000 MFI. Anything over 5000 is considered high risk.

In cadaveric transplants, the unpredictability of donor availability complicates desensitisation, which requires careful timing and immune suppression. This makes it rare and rarely successful in such scenarios.

Pre-emptive desensitisation therapy

In the case of 27-year-old Sai, a patient from Nandyal suffering from end-stage kidney disease due to IgA nephropathy, the MFI was alarmingly high, around 16,000. Sai had been on dialysis and was registered under the Jeevandan cadaveric organ donation program.

Sai first visited KIMS Hospital, Kurnool, six months ago. The nephrology team, led by Dr Anantha Rao, senior consultant nephrologist, initiated a desensitisation protocol—an unusual step for a patient awaiting a cadaveric donor.

The treatment included plasma exchange therapy to physically remove harmful antibodies from the bloodstream, intravenous immunoglobulin (IVIG) injections to stabilise the immune response, and long-term immunosuppressive medications to maintain reduced antibody levels while awaiting a donor organ.

After the 15-day therapy cycle, the medical team continued to monitor the patient closely over several months. When a kidney became available through the Jeevandan program, Sai’s antibody levels had remained sufficiently low, allowing for a safe transplant. The surgery was completed successfully, and the patient has since been discharged in stable condition.

A rare precedent in Indian medical practice

Desensitisation is typically performed only in live donor transplants, where the donor surgery can be coordinated precisely with immune preparation. Very few documented cases exist globally of such an approach being applied to cadaveric transplants, due to the uncertainty in organ availability.

Dr Anantha Rao said the success of this case challenges previous assumptions about what is possible in highly sensitised patients.

“This case shows that even in the most complex scenarios, successful organ transplantation is possible. Our approach could be a ray of hope for other highly sensitised patients waiting for a cadaveric organ,” he said.

The team at KIMS Kurnool is preparing to publish this case in a peer-reviewed journal, given its potential significance in transplant medicine.

Broader implications

This development highlights a possible shift in transplant protocol for sensitised patients. With proper desensitisation infrastructure and careful monitoring, patients who were once considered ineligible for cadaveric transplants may now have a viable path forward.

In centralised organ donation systems like Jeevandan, where organ matching is managed efficiently across the state, such pre-emptive immune conditioning could become a more widely considered option, especially for younger patients on long-term dialysis with no living donors.