Blood group incompatible kidney transplantation - new hope for patients

Wednesday, 26 May 2010

The South West’s first blood group incompatible live donor kidney transplant has successfully taken place at Bristol’s Southmead Hospital. Southmead is currently the only hospital in the south of England – outside of London – to offer this procedure.
Blood group in-compatibility between donor and recipient used to be considered an absolute biological veto against proceeding to transplantation.
This is because antibodies present in the recipient’s blood against the incompatible blood type can cause immediate and catastrophic rejection of the transplanted organ.
Previously, even if a willing and medically fit family member was available to donate a kidney to their loved one on dialysis treatment, transplantation could not proceed if the donor and recipient were blood group incompatible.
Approximately one in three potential kidney donations from family members have failed to proceed to transplantation due to this reason in the past. Recent advances in the field have led to treatments that safely remove these harmful antibodies enabling the recipient to receive an organ from a donor despite having an incompatible blood group.
Mark Trimby (47) an engineer from Bradley Stoke received a new kidney from his daughter Carly (24), in March using a new technique originally pioneered in Japan that could potentially offer hope to more patients with advanced kidney failure.
After suffering for more than 10 years with chronic kidney disease, Mark’s condition worsened considerably around 12 months ago. Doctors told him he needed a new kidney and he was put on dialysis three times a week.
At the same time his wife came forward to see if she was compatible to give him her kidney but after tests, doctors discovered kidney stones which meant that she would not be able to donate.
His daughter Carly also volunteered but, after tests, father and daughter were declared incompatible due to their specific blood group pairing – Mark was ‘O’ and Carly was ‘A’. Mark, as expected, had anti-blood group ‘A’ antibodies in his blood.
Mark was then put on the organ donor list with no way of knowing when a compatible kidney would become available.
Carly, who also lives in Bradley Stoke and works as a Catering Assistant at John Lewis, said: “My dad’s condition was really deteriorating by this point and he had to endure hours of dialysis each week. Donating my kidney to my dad was something I really wanted to do.”
The new procedure involves giving an extra anti-rejection drug (Rituximab) to help switch off the cells in Mark’s body that generate anti-blood group 'A' antibodies plus a treatment called plasma exchange, which removes the antibodies that are already present in Mark’s blood. The plasma exchange treatment needs to be carried out several times before the transplant operation to ensure that the recipient’s body accepts the new kidney.
After this, as with any kidney transplant, the recipient then has to take routine anti-rejection drugs indefinitely. Two months on and Mark’s new kidney is working perfectly well.
He said: “I have much more energy now and my appetite has come back. My general well-being has improved and I can now play with my grandchilden without getting tired.”
Dr Rommel Ravanan, Consultant Nephrologist, who supervised the procedure for Mark and Carly at Southmead Hospital, said: “This is a first for North Bristol NHS Trust and it really does offer donors and recipients in Carly and Mark’s situation a way forward without having to wait for a kidney to become available via the list.
“Living kidney donor transplantation is the gold standard treatment for advanced kidney failure and any advancement that increases the number of such transplants will mean the best available treatment is an option for patients.
“With this development, North Bristol NHS Trust is in a position to offer truly cutting edge care to patients (and their families) with advanced kidney failure in the South West.”

Mark added: “I am so proud of Carly and will be forever grateful for what she has done for me. I’m looking forward to the future with more confidence now.”