I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: Transplant Discussion => Topic started by: Amanda From OZ on July 31, 2007, 05:27:01 PM
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My doctor has constantly said no to a ABO incompatible Tranplants. I had a few donors (family) who were willing and would of passed the checks with flying colours, but my specialist said that he would not want me to do this type of transplant unless it was life and death situation.
Does anyone know why some doctors might say no to this and others are all for it? he said for older people it might be OK but not me because I'm young?... i can honestly say i believe my doctor is the greatest and i trust his judgment but why do u think this is the case?? it's kinda frustrating because I've read on here about all the successful ABO incompatible Tranplants but my doc says NO! :-\
Thanks
Amanda
xxoo
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My guess is that it is more risky for this type of transplant. Maybe if you wait for the right match it will last you for years.
What do they say "The best things in life are worth waiting for"??
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It may be due to that such transplants do not last as long and he is looking out for your future because of that.
Since you are young it is better to have a transplant that will last the longest possible time. This would be because as a younger person it is most likely you will go through more than one transplant in your life. After having a transplant it will screw with your antibodies and most likely raise your PRA and then if any future transplants are needed, it gets much harder to match you because of these new antibodies and high PRA level.
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Jenna was also advised against a ABO incompatible transplant. The surgeon said it is still a relatively new procedure as transplants go, and he would also like to see more long term results. He also said if it was an older patient, with no other options, and not doing well on dialysis, then he might recommend it. The other issue is that very few hospitals perform these transplants. Preconditioning is done to cleanse the blood of antibodies, depending on the patient's blood type and the amount of antibodies present. In general, it involves some combination of the following therapies before transplantation:
* Plasmapheresis — to physically remove antibodies.
* Immunoglobulin — also called gamma globulin, which appears to decrease antibody activity destructive to the graft. The mechanism is poorly understood since gamma globulin are themselves antibodies that disarm foreign antigens by binding to them.
* Splenectomy — the spleen concentrates B lymphocytes around its blood vessels to fight infection so removing it in a person with very high levels of antibodies wards off graft rejection.
* Anti-CD20 antibody (rituximab) — depletes the CD20 protein, which is found on the wall of most B cells.
There's more info here, if you're interested: http://discoverysedge.mayo.edu/abo_posxmatch/
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Amanda my doc said exactly the same. My brother is ABO Incompatable and wanted like crazy to donate and was pissed when they said no. I asked the doc and he basically said well it's a rarely done procedure (I believe Royal Melbourne has done about 7 of them?? something like that) and that there were other options. Since I was doing "well" on dialysis and was only a year on the transplant list well there was every hope that a donor would come along that way.
As karol said about what Jenna's doc said - he basically said the same that if things went downhill on dialysis and/or I'd been waiting too long on the transplant list etc then they might reconsider the decision but I definitely got the feeling that he/they just didn't want to go down that path unless I was on death's doorstep.
I do trust my doc. He's the head of medicine for a major university here and highly regarded - not some newbie - so I guess that's what I really have to go on. I did consider approaching Royal Melbourne with my brother about it but that kind of feels like going behind my doc's back somehow.. so I dunno.
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What is ABO incompatible ?
The only thing my doctor ever tell me was the kidney is belong to a young patient and it is compatible to you. Is it because my kidney is from a cadaver therefore, it is take it or leave it?
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What is ABO incompatible ?
The only thing my doctor ever tell me was the kidney is belong to a young patient and it is compatible to you. Is it because my kidney is from a cadaver therefore, it is take it or leave it?
ABO incompatibility refers to the immune reaction that occurs when different blood types are mixed together. This is when a patient has a living donor that is not the same blood type.