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Blood-washing’ allow transplant patients to receive incompatible kidneys

Great Ormond Street Hospital can now transplant kidneys from blood group incompatible donors, thanks to a new method that strips a patient’s blood of antibodies (proteins) before they have the transplant. For some children with kidney failure or on dialysis, this could mean that a parent who thought they were unable to donate could, in fact, donate their kidney and improve their child’s life.

Although common in adults, this type of transplant has rarely been carried out in children in the UK. Previously, the blood group of the child receiving the kidney had to be compatible with that of the donor, to prevent the kidney being rejected. Around 40% of parents have been unable to donate a kidney to their child for this reason.

Techniques have now been developed which allow blood group antibodies to be removed in some patients awaiting transplant. These include different types of ‘plasma exchange’ which allows the removal of plasma from the blood, to be replaced with new plasma. By removing the plasma, antibody levels in the blood fall. A further technique involves using a column to specifically remove the antibody.

The plasma exchange is a similar procedure to haemodialysis, which involves the blood passing through a filter. It is carried out in the week prior to the transplant, to ensure that antibody levels in the blood drop to sufficiently low levels. Stronger immunosuppressant drugs are also used to prevent rejection of the new organ.

GOSH has the largest paediatric nephrology unit in the United Kingdom with clinical and academic achievements.
Our unit has special expertise in the care of very young children with kidney disease, including acute kidney injury and chronic kidney disease and provides a comprehensive inpatient and outpatient diagnostic and treatment service for children.
Four patients have already received these types of ‘incompatible’ transplants, since the hospital started carrying them out in 2010.

In 2013, the hospital performed 28 kidney transplants in total, with 16 organs coming from living donors.

Dr Stephen Marks, a consultant kidney specialist who leads the kidney transplant programme at Great Ormond Street Hospital, says: “The potential benefits for patients are huge. Some patients may be able to receive a kidney transplant from one of their parents, who previously was told that they could not be a donor. There are risks involved in any transplant, but these patients can potentially go home within ten days, the same as they would after a ‘normal’ kidney transplant.”

Dr. Stephen Marks, Consultant Paediatric Nephrologist was recently named as one of “The Times” Top 100 Children’s Doctors in the United Kingdom.

Dr. Stephen Marks is a Consultant Paediatric Nephrologist, Honorary Senior Lecturer and Clinical Lead for renal transplantation at Great Ormond Street Hospital and UCL Institute of Child Health. He currently chairs the national organisation of paediatric renal transplantation (NHS Blood and Transplant Paediatric Kidney Advisory Group) in the UK.

Maya’s story
Maya is a 9-year old girl from Northolt who was first admitted to Great Ormond Street Hospital (GOSH) in 2008, after a bacterial eye infection led to more serious complications with her kidneys. She was diagnosed at age 4 years with a rare condition known as aHUS (Atypical Haemolytic Uraemic Syndrome). Maya eventually lost function in both of her kidneys. She was started on daily peritoneal dialysis, but after two years her catheter had to be removed due to an infection.

Maya and her mum Sylvia then spent three days a week travelling to GOSH for haemodialysis treatment. They then joined a new haemodialysis programme run by the hospital, enabling Maya to have the treatment in her own home. Sylvia was fully trained in using a haemodialysis machine, which replaces the work usually done by the kidneys and removes waste products from the blood.

“She missed so much school because of the dialysis and hospital stays, but she can go to school five days a week now,” said Sylvia after starting the home haemodialysis regime.

Maya, living with end-stage kidney failure, continued to be treated with home haemodialysis whilst awaiting a kidney transplant.

In 2013, thanks to the new procedure, Maya was able to receive an ‘incompatible’ kidney from her father, and end her reliance on haemodialysis.

Sylvia says: “This horrendous and terrible disease ravaged Maya’s little body in weeks and at one stage left her fighting for her life.

“Since Maya has had the transplant our lives have changed profoundly. We have become a family again and we make the most of every single day. We’ve come a long way but left the misery, pain and sorrow behind us now. Maya was given the gift of new life and words cannot possibly describe how grateful we are”.

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