Kidney ‘defroster’ to save thousands on transplant list

APIONEERING technique which allows surgeons to ‘defrost’ donor kidneys that have been on ice has been hailed by experts as ‘the dawn of a transplant revolution’.

Doctors hope that the remarkable procedure – known as normothermic perfusion – will help slash waiting lists by ten per cent over the next five years.

The method has already been successfully performed in 40 transplants at Leicester Hospital and at Addenbrooke’s in Cambridge.

Surgeons are now extending the programme to larger trials at The Freeman Hospital Newcastle and Guy’s Hospital London and plan to roll it out nationally.

There are 7,000 men, women and children awaiting a kidney, and 3,000 transplant operations are carried out each year.

Research so far shows the ‘defrosting’ method improves the quality of the kidneys before transplantation, increases the likelihood of a successful operation and extends the lifespan of the transplanted organ, which is currently ten to 15 years.

Once removed, kidneys are stored at close-to-freezing temperatures in order to preserve tissues and prevent degradation before surgical implantation.

But low temperatures and other factors such as the age and health of the donor can also cause damage, meaning up to one in five donated kidneys cannot be used.

The new procedure, being offered to NHS kidney failure patients, involves gradually warming the organ while flushing it with highly-oxygenated blood from a blood bank, and anti-rejection drugs, before it is grafted into the recipient. The process takes about an hour.

The process also allows surgeon to see that the organ is working at an optimum level, and all transplants carried out after this have been successful.

‘This allows us to repair and revive damaged kidneys in a way that would otherwise be impossible, making many more kidneys available for transplant,’ says transplant surgeon Professor Mike Nicholson, who pioneered the technique.

Research suggests the procedure will mean organs can be successfully used after 20 hours outside a body, as the process reverses some of the damage caused by cold storage and also appears to reduce rejection rates.

The first British patient to receive a revived kidney was Deborah Bakewell, a 59-year-old grandmother from Lincoln, who was diagnosed at the age of 23 with polycystic kidney disease, a rare genetic illness that causes small fluid-filled cysts to form in the kidneys, which gradually expand over time leading to kidney failure.

Deborah began to feel the effects of her illness in her 40s when she started feeling increasingly exhausted and suffering from kidney infections. Before her transplant in December 2010, she was forced to spend nine hours, seven nights a week, on dialysis.

Deborah says: ‘It was explained to me that it would be a new technique. I realised I was going to be a guinea pig but I trusted Prof Nicholson’s judgment and jumped at the chance. I felt I had everything to gain.’

HER recovery after the transplant was ‘immediate and dramatic’. She says: ‘Five years on from my operation, I feel wonderful. I have more energy than ever.’

There are a number of factors that influence the length of time a donor kidney may last.

These include whether the kidney came from a living donor, how well it is matched in terms of blood group and tissue type, and the age and general health of the recipient.

Ninety per cent of kidneys last for a year or more and at least half of patients can expect their new organ to last for ten to 15 years.

Prof Nicholson, lead researcher for Kidney Research UK, said: ‘There’s often great reluctance among health professionals to use kidneys from marginal donors, as there’s no way to establish whether they will work.

‘Normothermic perfusion allows us to confirm whether they function adequately enough to be used for transplantation.’

UK charity The Kidney Research Foundation, which funded the project, welcomed the development, saying: ‘This technique maximises the use of poorer-quality kidneys which are often discarded.

‘We hope it will lead to hundreds more transplants being carried out each year and give fresh hope to the 6,000 people in the UK waiting for a kidney.’