Cutting Edge Kidney Transplants Open New Doors for Living Donors and Recipients with Mismatched Blood Types and Other Blood Incompatibilities
In a procedure hailed as providing new and life-saving opportunities to the thousands of people on the list for a kidney transplant, the transplant team at Georgetown University Hospital has, for the first time in the Washington, DC region, transplanted a kidney from a living donor to a recipient whose blood type did not match.
58-year-old Barbara Cullen of Silver Spring had been on the list for a transplant since 2005 when it became clear that polycystic kidney disease was ravaging her kidneys. She spent several uncomfortable months on dialysis. Barbara's sister, 55-year-old MaryBeth Mullen, also of Silver Spring, wanted to be her kidney donor. Even though the sisters were a genetic match, they had different blood types, meaning MaryBeth could not be her donor. Barbara would just have to keep waiting.
That is until Keith Melancon, MD, director, Kidney and Pancreas Transplantation Program at Georgetown explained the process involved in what's called an incompatible kidney transplant. Over the past several years, Dr. Melancon has worked to pioneer incompatible kidney transplants. In essence, the organ recipient goes through a series of procedures before transplant that "cleans" the blood and forces the blood to be compatible with the donor's despite the incompatibility.
"Ms. Cullen is type O, Ms. Mullen is type B. Normally we could not use her sister's kidney. Her body would reject it," said Dr. Melancon. "What we did was a procedure called plasma pheresis, where we pull the antibodies from Barbara's blood that would make her reject the organ from the other blood type. We cleaned her blood of these antibodies twice, one to two days before her transplant then twice again after the transplant."
"I feel like Dr. Melancon and my sister gave me a new lease on life. I was really sick and I needed something that I thought was literally a dead end. I really disliked dialysis. It was uncomfortable, I kept getting infections and I couldn't live my life as I wanted to. My sister is the real hero here," said Barbara Cullen.
"For years I thought I could never be the one," said MaryBeth Mullen, "and here I am. I was grateful to learn that there was another avenue we could explore and that the transplant team was so committed to creating a greatly improved life for my sister and other patients with kidney disease. From a medical point of view it was very easy for me. I'm just glad my sister has her freedom back and is off of dialysis."
Dr. Melancon said, "The big news here is that this can work with people even if they are not related. Although there are varying degrees of difficulty depending on the two blood types involved, we can usually manage that difficulty with anti-rejection medications. This is huge for people who have been waiting for a donor or who have a willing living donor with the blood type being the only obstacle."
"About 35-percent of willing kidney donors are disqualified because of mismatching blood types. This procedure overcomes a very large barrier and is really life-saving news for our patients," said Dr. Melancon.
The surgery took place September 18 and lasted about three hours. MaryBeth went home in three days. Barbara went home seven days after her transplant.
A chef by trade, Barbara says she now looks forward to doing what she loves which is teaching cooking classes.
"I think more people need to know that this kind of transplant exists because this opens up transplant to a whole new group of patients, including me," Barbara Cullen said.
In another first for Georgetown, Cynthia Preloh of Arlington became the first at the hospital to undergo a kidney transplant using a similar blood cleansing process in what is called a "desensitized" transplant, with her 23 year old son as the donor. Cynthia and her son were previously incompatible because her blood contained human leukocyte antigens (HLA's) that would have rejected her son's organ. They were also a "positive crossmatch," meaning Cynthia's antibodies reacted against her son's cells. A donor and a recipient need to have a negative crossmatch before transplant in order for the transplant to succeed.
Cynthia underwent a similar process of plasma pheresis and immune globulin treatments before her transplant. Then on October 2, 2008 the surgery was successfully performed.
"I was looking at seven or eight more years on dialysis waiting for a donor kidney. I have been so debilitated by diabetes; I had just ten percent of my kidney function left. I am so grateful to my son, who saved my life, and to Dr. Melancon and his team for making my transplant possible," Cynthia Preloh said.
"About one third of the nation's 60,000 people on the list for a kidney have someone in their family willing to donate, but are incompatible," said Dr. Melancon. "Procedures like the ones we have used here mean they can receive the gift of life sooner rather than later."
Media Contact: Marianne Worley
Patient Contact: 202-342-2400