Kidney transplantation offers the best treatment for patients with end stage kidney disease, but is severely limited by the lack of available donor organs, which is coupled with the high incidence of rejection following transplantation. Transplant surgery is safe and effective, but there is always the potential for the patients’ immune system to reject the new kidney. This rejection is a major complication in the first year after kidney transplantation, affecting up to one in three patients. Doctors and surgeons must be satisfied that the donated organs are as healthy as possible to reduce the chances of this happening.
Despite national campaigns to raise public awareness of transplantation and encourage more people to sign up to the organ donor register (you can sign up quickly here www.organdonation.nhs.uk), the numbers of donors still remains low. The issue is more complicated as many of the donated organs are badly injured and cannot be used, meaning doctors and surgeons cannot take the risk that the kidney might not work.
Dr John Stone has recently completed a PhD at the University of Manchester under the supervision of Dr James Fildes, with the aim of addressing these issues. John and the team have focused on developing a novel technique, known as ex vivo normothermic perfusion (EVNP) to improve poorly functioning kidneys before they are transplanted into the patient and reduce the chances of rejection. The technique keeps the donor kidney alive in a very similar environment to that in which it would exist in the human body. John and his colleagues can analyse the organ’s performance and see exactly how it would work when it is actually transplanted into the patient’s body. This allows them to properly monitor function and gives them greater certainty over whether an organ is suitable for transplantation.
The team have also identified that the donor kidney contains a large number of donor immune cells that are transferred into the recipient during the transplant procedure. These immune cells can cause rejection by ‘introducing’ the donor kidney to the patient’s immune system. However, they have used EVNP to remove a proportion of these immune cells with the aim of reducing the risk of rejection. The team believe their work has the potential to improve kidney transplantation by ensuring more kidneys are suitable for transplant whilst also improving patient outcomes.
The work is based at the Manchester Collaborative Centre for Inflammation Research. If you would like to read some of the scientific work carried out by the group then please follow the links here and here