Preparing for an ABO-Incompatible or Swap Transplant: What Tests, Medications and Hospital Stay Look Like

Medicine Made Simple Summary

Preparing for an ABO-incompatible or swap kidney transplant involves many steps, and understanding them clearly can reduce stress for patients and families. This guide explains what happens before the transplant, including necessary tests, counselling, medications, plasmapheresis (for ABO-incompatible cases), legal requirements (for swap cases), and the expected hospital stay. The aim is to help you understand the process in simple language so you know what to expect and how to prepare confidently for a safe and successful transplant.

Why Preparation Matters

Preparation is the foundation of a safe kidney transplant. These procedures involve not only surgery but also detailed evaluation, careful medical planning and coordination. In ABO-incompatible transplant, doctors must lower harmful antibodies. In swap transplant, hospitals must match multiple families and synchronise surgeries. Good preparation greatly improves success rates and reduces complications.

Two Transplant Pathways with One Purpose

Both procedures aim to help patients who cannot undergo a direct transplant because of mismatch.

ABO-incompatible transplant allows a kidney donation even when blood groups differ. Doctors use special techniques to remove antibodies and reduce rejection risk.

Swap transplant connects two or more families so that each patient receives a kidney from a compatible donor within the matched group. No antibody removal is needed.

Suggested image: Flowchart comparing ABO-incompatible vs swap paths.

Initial Tests Needed for Both Procedures

These tests ensure the donor and recipient are medically fit:

• Blood group test
• Kidney and liver function tests
• Complete blood count
• Blood sugar profile
• Viral screening: HIV, Hepatitis B, Hepatitis C, CMV
• HLA typing
• Crossmatch test
• Chest X-ray
• ECG and echocardiography
• Urine examination

Doctors use these results to confirm that both individuals can safely undergo surgery.

Why Crossmatch Testing Is Crucial

Crossmatch testing checks whether the recipient’s immune system will attack the donor’s cells. Even if blood groups match, a positive crossmatch means immediate rejection. In swap transplants, the goal is to find a donor who produces a negative crossmatch for the patient.

Extra Tests Needed for ABO-Incompatible Transplant

ABO-incompatible transplants require additional testing to measure anti-A or anti-B antibody levels, known as titres. These titres tell doctors how strong the immune reaction may be. Patients with high titres may need more sessions of plasmapheresis or additional medicines before surgery.

Understanding Plasmapheresis

Plasmapheresis is a procedure that removes harmful antibodies from the patient’s blood. It usually starts one to three weeks before transplant. Each session lasts a few hours. After each session, doctors check how much the antibody levels have dropped. Once titres reach a safe zone, the transplant can be scheduled.

Suggested image: Diagram showing blood flowing through plasmapheresis filter.

The Role of Rituximab

Rituximab is a medicine that reduces B-cells—the cells that produce antibodies. It is commonly given one to three weeks before transplant. This helps prevent a sudden rise in antibody levels after plasmapheresis and protects the new kidney.

Medications Used Before ABO-Incompatible Transplant

Some medicines begin before surgery to help the body accept the kidney:

• Tacrolimus
• Mycophenolate mofetil
• Steroids
• Preventive antibiotics or antivirals
• Rituximab (when required)

These medicines gently prepare the immune system for the transplant.

Preparing for a Swap Transplant

Swap transplant does not require plasmapheresis or antibody-lowering drugs. However, it requires high coordination because surgeries for all families must happen on the same day. Each donor and recipient undergoes full evaluation, counselling and documentation.

Legal Requirements for Swap Transplant (India)

Swap transplant is legally permitted under the THOTA Act. The following documents are required:

• Identification proof
• Relationship proof
• Medical reports
• Consent forms from each donor
• Recent photographs

Families also attend a joint interview with the Authorization Committee to ensure the process is ethical and voluntary.

Counselling Before Transplant

Counselling plays an important role in preparing donors and recipients. Doctors explain the surgery, risks, recovery timeline, long-term medications and lifestyle changes. This step ensures that all individuals understand the process clearly and feel prepared.

How Donors Are Evaluated

Donors undergo a detailed assessment which includes:

• Kidney CT scan for structure and vessel mapping
• Fitness evaluation by the anaesthesia team
• Blood and urine tests
• Psychological counselling

Only donors who meet strict medical criteria are approved.

Hospital Stay During ABO-Incompatible Transplant

The hospital stay is slightly longer because antibody removal is done inside the hospital. Patients may be admitted several days before the transplant. After surgery, monitoring is very close. Doctors watch antibody levels, kidney function and urine output daily. Some patients may need additional plasmapheresis after surgery.

Hospital Stay During Swap Transplant

Swap transplant admission is simpler. Donors usually stay three to five days, while recipients stay around seven to twelve days. All surgeries are done at the same time across the participating families. Recovery after swap transplant is similar to recovery after a regular kidney transplant.

Recovery After Surgery

Most patients notice a big improvement in urine output after surgery. Appetite slowly returns. Some pain around the surgical area is normal. Patients take immunosuppressive medicines daily and have frequent blood tests during the first few weeks. Infections must be avoided by following hospital advice carefully.

How Recovery Differs Between the Two Procedures

ABO-incompatible patients may experience more frequent monitoring because antibodies can rise again after surgery. Swap patients, however, generally have a smoother recovery since the kidney is naturally compatible.

Possible Risks During Preparation and Recovery

ABO-incompatible:

• Antibody rebound
• Infection due to higher immunosuppression
• Longer hospital stay
• Electrolyte imbalance

Swap transplant:

• Delays due to scheduling multiple families
• Entire swap chain depends on all donors’ readiness
• Requires strict legal approval

Preparing at Home Before Transplant

A few simple steps help make recovery smooth:

• Arrange a clean room for rest
• Keep medicines organised
• Plan simple meals
• Arrange for family support
• Keep documents in one place
• Plan transport for frequent follow-ups

Conclusion

If you are preparing for an ABO-incompatible or swap kidney transplant, begin your evaluation early. Speak with your transplant team about your antibody levels, swap possibilities, number of plasmapheresis sessions needed and estimated hospital stay. Preparing early helps you avoid complications and sets the foundation for a smooth recovery. Book a pre-transplant assessment with an experienced transplant centre today.