Like most mothers, Kathy Doedderlein, of West Chester, PA, loves to talk about her son and his accomplishments. But her biggest boast about him has nothing to do with his education, career or family. It has to do with a physical sacrifice he made for her: one of his kidneys. In June, Kathy’s son donated a kidney so that his mom did not have to wait indefinitely for a cadaveric kidney transplant. Three months later, mother and son are doing exceedingly well.
“Three days after surgery, Jason was walking around, enjoying Baltimore’s inner harbor,” says Kathy. “Although I developed pneumonia, had a few other glitches after the transplant and had to stay in the hospital for four weeks, I am doing great now. The hard part is remembering to take my meds on schedule,” she adds.
Kathy’s story illustrates a growing trend for live organ donations of livers and kidneys. The impact is enormous: as transplant waiting lists grow for cadaveric donors, people are deciding to donate their organs. Kathy notes that ten people, a number of them friends, offered their kidneys to her. Most live donors are related to the recipients, but there are some unrelated altruistic donors—sometimes even unknown to the recipients.
Encouraging the living donor trend is the latest breakthrough in kidney transplantation: The Incompatible Kidney Transplant Program, the first of its kind in the nation. The transplant team at Hopkins has pioneered several innovations that now make it possible for any patient with renal failure to receive a kidney from any donor, regardless of his or her blood or tissue type.
Patients whose blood or tissue types are incompatible with their donors undergo plasmapheresis, which is similar to dialysis. The procedure removes the plasma portion of the blood, where harmful antibodies are located. After each plasmapheresis, the recipient receives an intravenous infusion of immune globulin to replace antibodies needed to fight infections and help prevent harmful antibodies from returning. To increase the chances of success, the recipient requires additional immunosuppressive medication and may need additional plasmapheresis treatments and a kidney biopsy.
Although the procedure is in its infancy, successful outcomes have been the norm, according to Robert Montgomery, M.D., Ph.D, Assistant Professor of Surgery, who spearheads the program at Hopkins.
The results are comparable to those achieved with compatible kidney transplants. Worldwide, 82 percent of blood type incompatible kidney transplants are working one year after transplant and 78 percent are functioning 5 years post-transplant. The transplant team at Hopkins is confident that their protocol will yield even better results than those of others in the past.
“This procedure has eliminated the barrier that has kept thousands of patients from receiving a life-saving transplant,” says Dr. Montgomery. Of the roughly 12,000 kidneys transplanted in the U.S. annually, about 5,000 are from live donors, but one-third of the recipients are not good matches with these potential donors, either because their blood types are incompatible or because they have developed antibodies against donor tissue. This can happen because of previous transplants, blood transfusions or pregnancies.
Last year, Susan Matthews, of Passadena, CA, was about to receive a transplant from a friend. At the last minute, however, her friend backed out. Susan’s son Kevin decided he wanted to donate his kidney to her. But there was one problem: Susan’s blood type was O Positive; Kevin’s was A Positive. Susan learned about the Incompatible Kidney Program at Hopkins. Her son was ecstatic about the idea of being able to help. So they flew to Baltimore six months ago to be evaluated.
Susan says the plasmapheresis was no big deal. After all, “I was used to dialysis, so being hooked up to a different machine wasn’t much different.” The surgery that followed went pretty smoothly. She did have her spleen removed, which is part of the protocol because the spleen is where antibodies are produced. As a result, Susan needs to take penicillin for the rest of her life. She and Kevin recovered quickly and completely.
The procedure is more complex than a regular live kidney donation, but it provides yet another option for kidney recipients as they undergo dialysis and wait for a suitable donor. A live donor kidney lasts about twice as long as a cadaveric kidney.
At Johns Hopkins, living donor programs are nothing new. Hopkins conducts one of the largest living liver donor programs in the country—and one of the oldest. In 1992, when the shortage of suitably sized organ donations for children was especially severe, the transplant team at Hopkins performed the first adult-to-child living donor transplant in the region. Over 40 more such transplants have been performed at Hopkins since then, including the first adult-to-adult liver transplant in the Baltimore-Washington area in 1998.
In that case, Daniel Reilly made history in the mid-Atlantic region by donating part of his liver to his mother, Kathleen. Daniel was hospitalized for eight days; Kathleen for 13 days. Mother and son, from Oceanport, NJ, are doing well almost four years later.
Because the liver is the only organ that can regenerate, the donor ‘s liver will be restored to its original size quickly, often within a month. In fact, up to 60 percent of a donor’s liver can be removed and the donor can maintain liver function until the organ regrows. Live donor transplant permits the procedure before a patient becomes critically ill, greatly improving the survival rate, in most cases to 90 percent. The procedure has its risks for the donor, but the likelihood of mortality in a healthy donor is less than 1 percent.
According to Andrew Klein, M.D., Chief, Division of Transplantation at Hopkins, despite some pain and discomfort after the operation, donors generally recuperate fully. “Once the postoperative recovery is complete, donors can expect to return to normal activities without restrictions,” says Dr. Klein.
These exciting techniques in live kidney and liver transplants will become routine with time. With kidney and liver disease at an all-time high, live donors provide a viable option to waiting lists and dialysis. The personal rewards for the donor are great, and the recipient will gain a new lease on life. “I admire my son for the person he has become,” says Kathy Doedderlein. “If I had known about this gift he was going to give me later in his life, I would never have grounded him as much as I did when he was a child,” she jokes. As for Jason, he says he’s now covered for Mother’s Day—forever—and he has absolutely no regrets.
Bridges Fall 2002
