New treatment leads to successful kidney transplants in 'untransplantable' children

A treatment that allows for kidney transplantation in patients who have rejected previous transplants has been carried out in a child for the first time in the UK at Great Ormond Street Hospital (GOSH).

The technique means that children deemed untransplantable due to their high levels of powerful antibodies can receive organs successfully.
Kidney transplants are sometimes rejected due to proteins that fight against foreign objects or organs in the body. These proteins, known as human leukocyte antigen (HLA) antibodies, arise from previous transplants, blood transfusions or pregnancies and, when they exist, organ transplantation can become impossible.The percentage of children who have HLA antibodies is generally low, however the greater number of transplants a person has, the more chance that they will have these antibodies, which may react with future transplants. As multiple transplants are becoming more common in children, the number

Who have HLA antibodies is increasing meaning a greater number of organs are at risk of rejection and more children are denied a transplant.
A new technique, carried out by a team at GOSH, sets about removing HLA antibodies using a blood filtering process, called plasmapheresis, in which blood is taken out of the body, filtered to remove HLA antibodies and then re-introduced back in to the child. As there will still be antibodies in the body after plasmapheresis, which can react when the kidney is transplanted, this treatment requires strong drugs to be administered to children in order to dampen down the immune system and reduce the likelihood of the antibodies causing severe rejection of the kidney. In the past, patients would have lost these kidneys due to severe rejection, resulting in the need for for dialysis. In the first three months following transplant, the risks are high while the childs immune system is suppressed but patients are monitored closely and can usually go home after a few weeks.

Mr Nizam Mamode, Consultant Transplant Surgeon at Great Ormond Street Hospital, who led the team that carried out the procedure, says: I am very pleased that we were able to offer a child this transplant, which hopefully will give them a much improved, and longer, life. We have developed this programme to give similar children and their families hope, where previously none existed, and although this is only the first case, we hope to provide many more children with a new lease of life.

Dr Stephen Marks, Consultant Paediatric Nephrologist and lead of the kidney transplant programme at Great Ormond Street Hospital, explains: This is the first time this procedure has been performed in the United Kingdom in a child, which is important as children have different immune systems compared to adults. Historically, children with HLA antibodies would not be able to receive kidneys from living donors and would be on the waiting list for deceased donor kidney transplants with very little chance of being offered an organ.

He emphasises that "kidney transplantation offers the best quality and quantity of life for children with severe irreversible kidney failure and the new technique could make transplants possible in these children where they werent before, avoiding their reliance on dialysis."
The Nephrology department at GOSH provides a comprehensive inpatient and outpatient service for children with congenital and acquired kidney disease and is the largest paediatric Nephrology Unit in the UK, with clinical and academic achievements.
The clinical operations of the unit are led by a highly skilled and dedicated team of healthcare professionals and have an on-going renal replacement therapy programme that includes treatment with chronic peritoneal dialysis or haemodialysis and renal transplantation.

The team have particular expertise in patient pathways for living donor renal transplantation. The unit have recently performed successful living related kidney transplant on children from the United Arab Emirates (UAE), Libya and Kuwait.

Megans story
Megan, 14, years old was born with problems with her kidneys that led to her receiving a kidney transplant in her native Dublin in 2011. Megans body rejected the kidney leading to it being removed the following day and requiring life-saving dialysis on a daily basis.
Megan was placed back on the transplant list but her chances of getting a kidney were low. She had elevated levels of antibodies, meaning that chances of rejecting the kidney were high, and so her chances of receiving a further organ and having a successful transplant were very slim.
With almost no chance of a donor, the family felt helpless until Dr Stephen Marks got in touch and said he could help. He outlined a technique being carried out successfully in adults that flushed out HLA antibodies and could mean that Megans dad, Edward, who wasnt considered a viable option as a donor, could in fact give her his kidney.

After travelling to GOSH and having her antibodies removed over an intense week, she successfully received a kidney transplant from her father. After the transplant, the family noticed an immediate difference in Megan with Megans mum, Carol, saying it was like she had come to life in front of our eyes. Her hair was glossy, eyes were bright, colour in cheeks and she was the child that we should have had before. Megan also commented that for the first time in my life, my eyes are open."

Three months on and Megans immune system is almost up to full strength. The change in Megan is visible both day and night and shes a happy, normal child. Shes not tired anymore and has got her life now.
Carol says: It was fantastic of Dr Marks and Mr Mamode to take us on. We were at our wits end and we felt like all avenues led to a brick wall.
While both parents still stress the need for organ donation they believe the 80 per cent success rate of this procedure offers families in similar situations real hope for the future.

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