Transplanting The Untransplantable

By Rea Blakey

CNN Medical Unit

Doctors at Johns Hopkins Hospital in Baltimore hope a radical new approach to organ transplantation will cut the number of people waiting for a replacement organ.

"This procedure has the potential of increasing the number of living donor transplant operations by one third to one half," said Dr. Robert Montgomery, Johns Hopkins transplant surgeon and lead author of a recent report on the breakthrough.

It usually takes a compatible match between the donor and the recipient to have a successful organ transplant. But doctors at Johns Hopkins have seemingly found a way to trick nature.

During the past two and a half years, they have successfully transplanted new kidneys into 27 patients from donors whose blood type does not match the recipients.

Bill Freeman was the first patient to undergo the experimental procedure. He doesn't mind being a human guinea pig.

After all, it allowed him to walk away from four years of dialysis, avoid waiting on the kidney transplant list for another four years, and get a new healthy functioning organ -- without having to find a donor whose blood and tissue type match his.

"Now I have a new lease on life. I have a new kidney," Freeman said. "I always say I carry a part of my wife around with me every day."

Freeman's wife donated his new kidney, despite the fact their blood types are incompatible.

The theory that a non-matching kidney transplant could work was formulated after transplant surgeons at Johns Hopkins realized they were already "rescuing" kidneys from being rejected after transplants in cases where blood types did match.

"Rescues" are necessary when a recipient's body begins to reject a transplanted kidney by building antibodies to it.

"So we said to ourselves, if we can remove antibodies from someone who's in the middle of a terrible rejection, and save those kidneys, then we should be able to remove them before surgery," Montgomery said.

They use a centrifuge to separate the plasma from the cells of a recipient's blood. The process is called plasmapheresis.

Plasma contains our defense forces -- antibodies. By removing the antibodies, doctors make it less likely the body will reject the new kidney.

"Usually there are four or five treatments that are done before the transplant and then after the transplant they have an additional two or three treatments," Montgomery said.

In a research paper recently presented at the American Transplant Congress, Montgomery reported a 93 percent success rate: 27 of the 29 patients with transplants are reportedly doing well.

Montgomery said one patient died due to surgery complications. Another transplanted kidney failed because the patient stopped taking daily medications to keep blood antibodies at bay, he said.

As in conventional transplantation, patients must take anti-rejection medication for life.

"Many of these patients have been repeatedly told there is no hope of ever receiving a kidney transplant," Montgomery said.

"With this innovation, I can tell any patient who has a live donor and is medically eligible that they can be transplanted with a high likelihood of success."

"The plasmapheresis is something I wouldn't wish on anyone," Freeman said of the five-hour treatments. He received his wife's kidney on his 50th birthday; that was two and a half years ago.

More than 50,000 Americans are waiting for a donated kidney. Doctors hope that performing a series of plasmapheresis procedures both before and after kidney transplantation from a living donor will dramatically reduce the waiting list.

And someday, Montgomery said, the innovative process might also help those waiting for other organs such as livers.

Copyright © 2002 CNN.

This article posted June 2, 2002.