"Triple Swap" Kidney Transplant Operation a Success

Johns Hopkins Medicine
Office of Communications and Public Affairs
March 4, 2004
MEDIA CONTACT:  Trent Stockton
PHONE:  410-955-8665
  [email protected]

Surgeons at The Johns Hopkins Comprehensive Transplant Center on Feb. 29, 2004, performed what is believed to be the world's first "triple swap" kidney transplant involving a new technique, called plasmapheresis, for removing the harmful antibodies that create incompatibilities between donors and recipients. 
"We are trying to start a revolution here.  By combining kidney exchanges with plasmapheresis, virtually any incompatible donor and recipient now have the opportunity to give and receive a kidney," says Robert A. Montgomery, M.D., Ph.D., lead surgeon on the case and director of the incompatible kidney transplant programs (InKTP) at Johns Hopkins. "All three kidneys are working well, and the six donors and recipients are quickly recovering."
The three organ recipients had come to Baltimore separately in the hope of receiving the new therapy offered by Johns Hopkins that could remove harmful antibodies causing the incompatibilities with their loved ones.  But their hopes were dashed when Johns Hopkins physicians found that the level of harmful antibody in the blood of each patient was so high that even the new technique could not help them.  These harmful antibodies would cause an immediate rejection of a new kidney from their loved one.  They each went home with what seemed like their last option taken away.
Then the Johns Hopkins' transplant team discovered that by swapping kidneys among the pairs, they could "trade up" to either compatible matches or low levels of antibodies that would be amenable to removal by plasmapheresis.  One of the three recipients received six plasmapheresis treatments, in which the patient's blood is filtered of the harmful antibodies, in preparation for the "triple swap."

"These matches are only limited by the size of the pool of patients they are drawn from," says Montgomery.  The more patients, the more possible matches.  If we could start a national list of incompatible donors and recipients, we could get hundreds or perhaps thousands of additional transplants done each year."
The Hopkins team performed its first "triple swap" kidney exchange on July 28, 2003, building on the success of the paired kidney exchange program which it began in 2001.   In a paired kidney exchange, incompatible donors agree to give a kidney to a stranger in order for their loved one to receive a kidney in exchange.  To date, Hopkins surgeons have performed seven paired kidney exchange transplants, but the Feb. 29 exchange was the first in which plasmapheresis was utilized.  Adding plasmapheresis to the mix means that the matches do not have to be perfect. The kidney survival rate is 94 percent in this group. 
Sunday's cases mark the second time surgeons exchanged kidneys among six people in the United States.  The recipients are Shawn Moyer, 34, of Dover, Pa.; Mike Mooneyham, 42, of Kingsport, Tenn.; and Kendall Wyman, 31, of Glendale, Calif.  The donors are Alyssa Moyer, 32, of Dover, Pa.; Cathy Mahoney, 49, of Oakland, Calif.; and Richard Wyman, 59, of Norwalk, Conn.
"It is through the donors' generosity and flexibility that we are able to make this happen," says Janet M. Hiller, R.N., M.S.N., a clinical nurse specialist for InKTP who along with Jennifer Rickard, R.N., B.S.N., coordinated the patients' evaluations for transplant. "If we had more people willing to donate, we wouldn't have to go to these extremes."

More than 55,000 people are on the national waiting list for a kidney, according to the United Network for Organ Sharing.
For more information about Johns Hopkins' incompatible kidney transplant programs, call toll-free 888-304-5069 or 410-614-6074..
The other surgeons in the case were James Burdick, M.D.; Matthew Cooper, M.D.; Thomas Jarrett, M.D.; Seth Karp, M.D.; and Louis Kavoussi, M.D.
Related Web site:
The Johns Hopkins Comprehensive Transplant Center