First-ever ABH-incompatible Kidney transplant in Bombay blood group recipient
- Indian doctors achieve a groundbreaking feat -

Sivakumar Vijayaraghavalu *

In a groundbreaking achievement in the field of renal transplantation, doctors at MIOT International, Chennai, Tamil Nadu, have successfully performed the first-ever ABH-incompatible kidney transplant in a recipient with the rare Bombay blood phenotype.

This medical marvel, led by Dr Rajan Ravichandran and his team, has been published in the prestigious Kidney International Reports (Volume 10, Issue 2, Supplement, February 2025, Pages S510-S511).

The Bombay blood group, or ‘hh’ blood group, is an extremely rare blood type, first discovered in Mumbai in 1952. It affects one in four million individuals worldwide, making organ transplantation a daunting challenge due to the absence of H antigens on red blood cells.

Patients with this blood type can only receive organ or blood donations from other Bombay phenotype individuals, significantly limiting donor availability.

A Medical Breakthrough Against the Odds

A 30-year-old male patient suffering from End-Stage Kidney Disease (ESKD) due to IgA nephropathy faced a unique challenge when his medical evaluation revealed he had the Bombay blood group. His mother, the willing donor, had a ‘B’ blood type, making this an ABH- incompatible transplant—a feat never attempted before.

The medical team, led by Dr Rajan Ravichandran, along with Dr Yashwanth Raj T and Dr Kanakaraj Arumugam, designed a novel desensitization protocol to overcome the high risk of organ rejection. The treatment regimen included:

Rituximab 200 mg (to deplete B-cells responsible for antibody production)
Tacrolimus, Mycophenolate mofetil, and oral Methylprednisolone (to suppress immune response)
Three sessions of Therapeutic Plasma Exchange (TPE) with 5g of IV Immunoglobulin (IVIG) to reduce harmful anti-H and anti-B antibodies.

On the day of the transplant, the patient’s IgG Anti-H titre was successfully reduced to 1:16, while Anti-B titre was 1:8, making it possible to proceed with the surgery.

Successful Transplant and Post-Operative Stability

The kidney transplant was conducted with Basiliximab induction, and the patient exhibited excellent graft function, with a nadir creatinine level of 1.5 mg/dL post- surgery. His post-operative recovery was smooth, with no signs of hyperacute rejection—a significant concern in ABH-incompatible transplants. Two months post-surgery, the patient continues to maintain stable kidney function with a creatinine level of 1.6 mg/dL.

A Landmark Achievement in Renal Medicine

This case is the world’s first documented success of an ABH-incompatible kidney transplant in a Bombay blood group recipient. It provides a proof of concept that Anti-H iso-agglutinins can be removed through extracorporeal therapy, and IgG Anti-H titres of 1:16 post-TPE may be considered a safe threshold for renal transplantation.

Dr. Rajan Ravichandran and his team’s achievement marks a quantum leap in renal science, offering new hope for patients with rare blood groups who previously had no viable transplant options. This pioneering procedure is expected to open new avenues in ABO and ABH-incompatible transplant strategies, revolutionizing kidney transplantation worldwide.

Global Recognition and Future Implications

The research has been recognized internationally, with its publication in Kidney International Reports, a leading nephrology journal. This milestone sets a new benchmark in transplant medicine, potentially paving the way for more inclusive transplant criteria for rare blood group patients.

With this success, MIOT International has firmly placed India at the forefront of global nephrology and transplant research. The team’s indomitable spirit, advanced medical expertise, and groundbreaking innovation have made history in renal science—a truly Himalayan feat that will inspire future generations of medical professionals.