New blood-washing operation that's a lifeline for kidney patients
02:17 GMT, 3 July 2012
02:17 GMT, 3 July 2012
There is a desperate shortage of donor organs, exacerbated by the fact that the donor and recipient must have the same blood type.
With National Transplant Week starting on Monday, DAVID HURST talks to Charli Wheeler, 24, a student from Orpington, Kent, who had a new treatment that tackles this problem.
Key to success is ensuring all the antibodies – from the patient and the donor organ – are removed before the transplant and don't return
Even though I was four weeks premature, Mum says the doctors weren’t too worried about me.
But a few hours later they realised I had problems with my kidneys.
I was rushed to Great Ormond Street. It turned out only one kidney worked, and even that wasn’t working properly.
The doctors were worried I’d need a dialysis machine to clean my blood, which is what your kidneys are meant to do, and that I might even die.
I was diagnosed with a rare condition called Vater Syndrome, which causes birth defects in the body, including the kidneys.
I spent nearly two years in hospital; by the time I was two, I’d had 40 operations to get my kidney working better.
Over the years I was OK and had regular check-ups, though I’ve always been smaller than other girls.
Then everything started to go wrong after my 15th birthday — I felt tired all the time. At times I couldn’t get out of bed.
It turned out that, as I’d grown, my kidneys couldn’t do their job as well.
The doctor told me I had anaemia and all the toxins my kidneys were meant to get rid of were building up — that’s why I felt so rubbish. I’d need a kidney transplant.
It sounded scary, but I was told I might not survive if I didn’t have one as soon as possible.
My parents were tested to see if they were a good match.
Mum wasn’t, but luckily Dad was because we have the same blood group.
I had the transplant in 2002 when I was 15. I felt so much better and had lots more energy.
But, in 2005, I started to get really tired again — even climbing stairs was hard work.
Tests showed I was rejecting Dad’s kidney. I was so upset and thought I’d have to use a dialysis machine for years.
On Christmas Day, I started to feel really sick and by Boxing Day, I couldn’t breathe properly.
I was rushed by ambulance to Guy’s Hospital in London because my kidney was failing.
My skin was yellow and I felt terrible. My parents were terrified I wasn’t going to make it.
Then my consultant, Mr Koffman, said there was something new that might work.
I knew that the person giving you a kidney needs to have the same blood type as you or the body doesn’t like it.
He said they had special machines that could ‘wash’ my blood, so it wouldn’t reject a kidney from a donor with a different blood type.
That meant I could have a kidney from Mum — I couldn’t believe it.
I had the transplant in April 2009.
A week before, I had lots of drugs pumped into me to stop Mum’s kidney being rejected.
Then the plasma in my blood was removed and replaced. Plasma contains antibodies that can help your body reject the kidney, so clearing them away reduces the risk.
On the day, Mum had her kidney out at 1 pm and I received it half an hour later.
By 7 pm we were sitting in beds next to each other in the ward. Even by the next day, I felt so much better.
Now I have bundles of energy. My new kidney is working fine.
I’m so grateful to my parents — they really did save my life.
Geoff Koffman is a renal and renal transplant surgeon at Guy’s & St Thomas’s Hospital, London. He says:
Until recently, transplants between people with different blood groups were impossible.
With kidney transplants, not only did the blood group have to match, but the tissue type, too.
Rejection is caused by antibodies — proteins found in blood or other bodily fluids that act as the body’s natural defence.
They identify and neutralise foreign objects, such as bacteria and viruses, but also body tissue and blood groups that are different.
About 90 per cent of the time the patient’s parents will be the closest tissue match and able to donate a kidney.
But their blood group must also match, and this is only 50 per cent likely.
Now there is hope for patients thanks to a system developed in Japan a decade ago and refined at Guy’s.
It involves washing the blood to remove the antibodies that cause the organ to be rejected.
So it no longer matters what blood type the donor is.
It’s thought 30 per cent of patients waiting for a kidney are being held back because though they have a live donor with the right tissue type, their blood types don’t match.
This technique means these patients can come off the waiting list.
Using living donors has many benefits: a shorter waiting time for transplants; the organ usually works immediately — a deceased donor’s kidneys may take several weeks to work; and they can last much longer, 20 years rather than 12.
The key to success is ensuring all the antibodies — from the patient and the donor organ — are removed before the transplant and don’t return.
First, patients take drugs to stop their body producing antibodies and undergo a blood cleaning process, where the antibodies that cause rejection are filtered out.
The drug the patient is given, rituximab, suppresses antibody production.
This is administered ahead of the transplant along with other anti-rejection drugs.
Then the patient is attached to a machine to filter their blood of plasma — this is the liquid in blood that contains antibodies.
Before the patient’s blood is passed back into their body, donated plasma is added — known as plasma exchange.
The procedure takes three to four hours and is carried out on alternate days from a week before the transplant and for two days afterwards.
We do blood tests to check how well the patient’s body receives the foreign blood — if lots of antibodies are created, it might be that there will be too many to get rid of and that particular donor is unsuitable.
The operation is done using keyhole techniques.
Afterwards, patients need to take immuno-suppressive drugs for life, though this doesn’t mean the antibodies have returned.
This is a remarkable procedure that could save thousands of lives.
More than 7,000 people are on the kidney donor waiting list and 300 a year die while waiting for a donor organ. Now we’ll be able to help more people.
I can’t see any reason why it won’t be used for other organ transplants.
The operation costs the NHS 20,000. Information: 020 7188 7188; guysandstthomas.nhs.uk. NHS Organ Donor Register: 0300 123 2323; organdonation.nhs.uk.