[note: related graphic available on http://www.hopkinsmedicine.org/press/2003/August/030801.htm ]
Newswise — Surgeons with The Johns Hopkins Comprehensive Transplant Center on July 28 performed what is believed to be the world's first "triple swap" kidney transplant operation, giving a woman from Miami, a woman from Pittsburgh and a child from Washington, D.C., new leases on life.
The three organ recipients had come to Johns Hopkins separately for evaluation, each with a willing donor who was not of a compatible blood or tissue type. The transplant team discovered that by swapping the kidneys among the pairs, all three recipients would receive a compatible kidney from someone they had never met.
"This was truly a remarkable event - three patients who were not compatible with their donors could be transplanted because they were willing to exchange their donor's kidney for a kidney from another donor," said Robert A. Montgomery, M.D., Ph.D., lead surgeon on the case and director of the incompatible kidney transplant programs at Johns Hopkins. "We have created a type of matchmaker system that attempts to pair all of our incompatible donors and recipients. It is a win-win situation for everybody.
"We're very pleased with the outcome of Monday's marathon operations," he added. "All three kidneys are working well in their new homes. This is an exciting new way to get more patients transplanted in the setting of a critical donor shortage."
The Hopkins team performed the first paired kidney exchange in the United States in 2001, in which the donors of two incompatible donor-recipient pairs agreed to give a kidney to a blood-type compatible recipient of the other pair. To date, Hopkins surgeons had performed four of these transplants. This case, the fifth, marks the first time they have exchanged kidneys among six people.
In this case, Julia Tower, 56, of Hyattsville, Md., wanted to donate a kidney to her friends' son, Jeremy Weiser-Warschoff, 12, of Silver Spring, Md. As her blood type, O, is considered a universal donor, she was a blood match for Weiser-Warschoff, who is blood type A. However, she was not a good tissue match because of a similarity with Weiser-Warschoff's previous kidney donor, which would have put the child at risk for a particularly severe type of rejection. She also hoped Weiser-Warschoff could receive a kidney from a younger donor.
Paul Boissiere, 30, of Coral Gables, Fla., became that compatible donor. He wanted to donate a kidney to his fiancee, Germaine Allum, also 30 and from Coral Gables, but they were blood-type incompatible. He has A blood, and she has B. They, too, inquired about the exchange program.
The transplant team found the perfect bridge in a pair of sisters from the Pittsburgh area. Connie Dick, 41, of Latrobe, Pa., wanted to donate a kidney to her sister Tracy Stahl, 39, of Johnstown, Pa. They both had B blood types but tests revealed that Stahl had harmful antibodies, or blood proteins, that would attack and destroy Dick's kidney. In fact, Stahl had antibodies against just about everyone in the population tested and was considered to be essentially untransplantable. The sisters were approached about the triple exchange after it was discovered that Stahl could accept Tower's kidney without the risk of immediate rejection, a one in a million chance.
"It was through these donors' generosity and flexibility that we were able to make this case happen," said Janet M. Hiller, a nurse manager for the incompatible kidney transplant programs who identified the matches and coordinated the patients' evaluations for transplant. "This is one of several initiatives we have to increase the number of organs available for transplant. The logistics involved in pulling off six operations simultaneously were formidable."
While a blood-type compatible transplant is ideal, the Johns Hopkins team also has a program in place to transplant incompatible kidneys by putting the organ recipient through several plasmapheresis treatments, in which the patient's blood is filtered of harmful antibodies that would normally reject a donor kidney.
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 410-614-6074 or visit the Web site athttp://www.incompatiblekidneys.org .
The other surgeons in the case were Paul Colombani, M.D.; Matthew Cooper, M.D.; Thomas Jarrett, M.D.; and Louis Kavoussi, M.D.
Related Web sites:
Incompatible Kidney Transplant Programs at Johns Hopkinshttp://www.incompatiblekidneys.org/
The Johns Hopkins Comprehensive Transplant Centerhttp://www.hopkinsmedicine.org/transplant/
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