A treatment that allows for successful kidney transplantation in patients who have rejected previous transplants, has been carried out on an Irish child, Megan Carter from Coolook, Dublin, for the first time in the UK at Great Ormond Street Hospital. The technique means that children deemed ‘untransplantable’ due to their high levels of powerful antibodies can receive organs successfully.

Kidney transplants are sometimes rejected due to antibodies, known as human leukocyte antigen (HLA) antibodies, that fight against foreign objects or organs in the body. These antibodies arise from previous transplants, blood transfusions or pregnancies and, when they exist organ transplantation can become impossible. Around 30% of adults are thought to have HLA antibodies, which can cause serious complications post-transplant, including a severe rejection with loss of the transplant, infections, bleeding and even death.

The percentage of children who have these antibodies is generally low, however the greater number of transplants a person has, the more chance that they will have HLA antibodies, which may react with future transplants. As multiple transplants are becoming more common in children, the number who have HLA antibodies is increasing meaning a greater number of organs are at risk of rejection and more children are denied a transplant.

The new technique, carried out by a team at GOSH, sets about removing HLA antibodies using a filtering process of blood, called plasmapheresis, in which blood is taken out of the body, filtered to remove HLA antibodies and then re-introduced back in to the child. HLA antibodies are known to be difficult to remove from the body as it is harder to target them specifically than with other antibodies. As there will still be antibodies in the patient, which can react when the kidney is transplanted, this technique requires stronger immunosuppressant drugs to be administered to the patient in order to make sure that as many HLA antibodies are removed and to reduce the likelihood of them causing severe rejection of the kidney. In the past, patients would have lost these kidneys due to severe rejection, resulting in the requirement for dialysis.

In the first three months following transplant, the risks are high while the child’s immune system is suppressed but patients are monitored closely and can usually go home after a few weeks.

Dr Stephen Marks, Consultant Paediatric Nephrologist and lead of the kidney transplant programme at Great Ormond Street Hospital, explains: “This is the first time this procedure has been performed in the United Kingdom in a child, which is important as children have different immune systems compared to adults. Historically, children with HLA antibodies would not be able to receive kidneys from living donors and would be on the waiting list for deceased donor kidney transplants with very little chance of being offered an organ.”

He emphasises that “kidney transplantation offers the best quality and quantity of life for children with severe irreversible kidney failure and the new technique could make transplants possible in these children when it hasn’t been previously, avoiding their reliance on dialysis.”

Mr Nizam Mamode, Consultant Transplant Surgeon at Great Ormond Street Hospital, who led the team that carried out the procedure, says: “I am very pleased that we were able to offer a child this transplant, which hopefully will give them a much improved, and longer, life. We have developed this programme to give similar children and their family’s hope, where previously none existed, and although this is only the first case, we hope to provide many more children with a new lease of life.”

Mr. Mark Murphy, Chief Executive of the Irish Kidney Association said, “The Irish Kidney Association wishes to acknowledge the essential health care cooperation between the UK and Ireland. In the last three years 31 children from Ireland benefited from specialist organ transplantation conducted in UK Hospitals. Pediatric Kidney transplantation is routinely carried out in Temple Street Hospital. The nature of the complexities involved in re-transplanting Megan Carter again highlight the importance that a partnership approach to rare conditions that a country the size of Ireland will always require.”

Megan’s story

Megan Carter, 14 years old, from Coolock, Dublin was born with problems with her kidneys that led to her receiving a kidney transplant at Temple Street Hospital in her native Dublin in 2011. Megan’s body rejected the kidney leading to it being removed the following day and requiring life-saving dialysis on a daily basis.

Megan was placed back on the transplant list but her chances of getting a kidney were low. She had elevated levels of antibodies, meaning that chances of rejecting the kidney were high, and so her chances of receiving a further organ and having a successful transplant were very slim.

With almost no chance of a donor, the family felt helpless until Dr Stephen Marks got in touch and said he could help. He outlined a technique being carried out successfully in adults that flushed out HLA antibodies and could mean that Megan’s dad, Edward, who wasn’t considered a viable option as a donor, could in fact give her his kidney.

After travelling to GOSH and having her antibodies removed over an intense week, she successfully received a kidney transplant from her father. After the transplant, the family noticed an immediate difference in Megan with Megan’s mum, Carol, saying it was “like she had come to life in front of our eyes. Her hair was glossy, eyes were bright, colour in cheeks and she was the child that we should have had before.” Megan also commented that “For the first time in my life, my eyes are open”

Three months on and Megan’s immune system is almost up to full strength. The change in Megan is visible both day and night and she’s a happy, normal child. She’s not tired anymore and has ‘got her life now.’

Carol says: “It was fantastic of Dr Marks and Mr Mamode to take us on. We were at our wits end and we felt like all avenues led to a brick wall.”

While both parents still stress the need for organ donation they believe the 80 per cent success rate of this procedure offers families in similar situations real hope for the future.

For an organ donor card Freetext the word DONOR to 50050 or visit website www.ika.ie It is also possible to download an organ donor card on smartphones by searching for ‘Donor ECard’ at the iphone store or android market place. Your wishes to be an organ donor can also be included on the new format driving licence which is represented by Code 115.
For further information please contact:
Rachel Twinn – 020 7239 3039 (Great Ormond Street Hospital); rachel.twinn@gosh.org
Gwen O’Donoghue, Irish Kidney Association mob. 353 86 8241447
Mark Murphy, Chief Executive, Irish Kidney Association. Tel. 353 1 6205305 mob. 353 87 2571235
Notes to editors: Great Ormond Street Hospital for Children NHS Foundation Trust is the country’s leading centre for treating sick children, with the widest range of specialists under one roof. With the UCL Institute of Child Health, we are the largest centre for paediatric research outside North America and play a key role in training children’s health specialists for the future. Our charity needs to raise £50 million every year to help rebuild and refurbish Great Ormond Street Hospital, buy vital equipment and fund pioneering research. With your help we provide world class care to our very ill children and their families. www.gosh.nhs.uk

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