“Gift of time” could enable nearly 100 more kidney transplants each year
Kidney Research UK has today revealed that around 100 kidneys could potentially be saved for transplant each year after being retrieved from donors.
We looked at three years of data from NHS Blood and Transplant to determine the number of kidneys deemed clinically unsuitable for use.However, a new technique to better preserve kidneys before surgery could extend their viability and increase the number of kidneys available for transplant. The findings come as we mark Organ Donation Week – a time typically used to spread awareness around the benefits and impact that transplantation can have.
Extending a critical window
Kidney Research UK chief executive Sandra Currie explained: “Patients wait on average over a year and a half for a kidney transplant, some wait much longer and when they do receive the call, they can face a very difficult and tense time involving an urgent journey to the hospital to avoid the risk of missing out on a life-changing organ.
"Unfortunately, we know of many patients who have been called to hospital multiple times, only to be told the donor kidney cannot be used after all. One important reason for this is the very short time available currently to keep the kidney in good condition ahead of the surgery to transplant it. The research that we are funding aims to extend this critical window of opportunity from retrieval to transplant.”
With funding from Kidney Research UK, Dr John Stone and Professor James Fildes from Pebble Biotechnology Laboratories in Alderley Park, Macclesfield, have made significant progress in keeping retrieved kidneys viable for longer.
Their research uses normothermic perfusion, in which oxygenated blood is pumped through a kidney to simulate the flow of blood within an organ. Cold storage of the kidney is currently the standard method, but the longer the organ is on ice, the greater the chances of damage to the kidney. Perfusion could offer a solution to storage that does not impact the viability of the organ.
Current guidelines advise that perfusion should only be used to test the function of the kidney, ideally for less than three hours before the procedure causes injury to the organ. However, in an experimental setting, the team have developed a new protocol using ethically sourced pig kidneys, without evidence of injury at 24 hours. The team are now trying to extend perfusion into days.
Inspiration for the project came from John’s 11-year-old nephew, Luke, who received a kidney transplant from his own father in May this year. With the average transplant lasting for up to twenty years, John understands that Luke will probably need at least one more in his lifetime, meaning that his work could be crucial to giving his nephew a better outcome in the years ahead.
Dr John Stone, Senior Scientist at Pebble Biotechnology Laboratories said: “The clock is ticking as soon as you remove a kidney from a donor, you have a short amount of time before the organ is no longer viable.
"Transplant centres are under immense pressure to ensure the organ is not wasted but face operational challenges such as a lack of resources and sharing operating theatres with other departments, meaning that despite their best efforts, surgeons simply run out of time. So far, we have been able to keep a kidney on the perfusion circuit for twenty-four hours without causing damage.
"With current guidelines advising just three to six hours of perfusion, our methods could allow more time so more patients receive their life-saving transplant and fewer precious organs go to waste.”
Pushing the boundaries
The team believe that their methods could be adopted in a clinical setting within the next three years, directly addressing some of the logistical and operational issues across many NHS transplant settings.
John and the Pebble team are determined to push the boundaries of perfusion, not only to ensure every organ can be transplanted, but also to enable the development of new innovations, including genetic modification with gene therapies, the creation of synthetic blood cells, and novel immunomodulators that could prevent rejection.