A father and daughter are celebrating a milestone, a kidney transplant 50 years ago that changed the course of medicine.Ted Lombard gave his then-13-year-old daughter Denice a kidney to save her life.
Denice and twin sister Diane were born with a genetic defect which causes kidney failure.After Diane died at age 7, doctors wouldn’t put Denice on dialysis, saying it was too new and risky.
Her mother convinced UCLA Medical Center to do a living-donor transplant. It was experimental at the time.
“I lost one daughter and I just didn’t want to lose another,” said Ted.
Now, transplants – including those from living donors – are being done every day.
But the Lombards want everyone to consider becoming a living donor.
There are 100,000 people on the waiting list now and a new name is added every 14 minutes.The Lombards are believed to be the oldest living donor pair in the United States.
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- Among deceased donor kidney transplant recipients, those who were >30 kg (66 pounds) heavier than the donor had a 28% higher risk of transplant failure compared with equally weighted donors and recipients.
- If the kidney was from a smaller donor of the opposite sex, the relative risk of transplant failure was further elevated to 35% for a male receiving a kidney from a female donor and 50% for a female receiving a kidney from a male donor.
- More than 100,000 people are on the kidney transplant waiting list in the United States.
Washington, DC (March 30, 2017) — A new study indicates that the success of a kidney transplant may rely in part on a kidney donor’s weight and sex, factors that are not typically considered when choosing a recipient for a deceased donor kidney. The findings, which appear in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN), suggest that changes may be needed to current immunology-based protocols that match donors and recipients.
Previous research has shown that there may be a higher risk of kidney transplant failure if a kidney donor is smaller than the recipient, perhaps due to increased strain on the relatively smaller transplanted kidney. Very few studies have investigated outcomes associated with donor and recipient weight mismatch, however. There is also a suggestion that sex mismatch between kidney donor and recipient may lead to worse outcomes post-transplant, but studies have generated conflicting results.
To investigate these issues, a team led by Amanda Miller, MD and Karthik Tennankore, MD (Dalhousie University and the Nova Scotia Health Authority, in Canada) examined whether receiving a kidney transplant from a smaller donor of the opposite sex would impact a recipient’s transplant outcomes. The researchers analyzed information on a cohort of US deceased donor recipients between 2000 and 2014 who were listed in the Scientific Registry of Transplants Recipients. Over a median follow-up of 3.8 years, 21,261 of 115,124 kidney transplant recipients developed transplant failure.
After accounting for other transplant variables, the researchers demonstrated that if a kidney transplant recipient was >30 kg (66 pounds) heavier than the donor, there was a 28% higher risk of transplant failure compared with equally weighted donors and recipients. If the kidney was from a smaller donor of the opposite sex, the relative risk of transplant failure was further elevated to 35% for a male receiving a kidney from a female donor and 50% for a female receiving a kidney from a male donor. This risk is similar to that observed when a recipient receives a kidney transplant from a donor who has diabetes, a known risk factor for kidney failure.
“This study is extremely important because we have shown that when all else is considered, something as simple as the combination of a kidney donor’s weight and sex is associated with a marked increase in kidney transplant failure,” said Dr. Miller. “While more research is required before including these variables in a recipient matching strategy, this study highlights the importance of donor and recipient matching above and beyond current immunology-based protocols.”
In an accompanying editorial, Bethany Foster, MD, MSCE and Indra Gupta, MD (McGill University) noted that while matching for sex and body size in organ allocation algorithms deserves consideration, this idea must be approached with a great deal of caution. It would require complex matching, and special care would have to be taken to avoid disadvantaging larger recipients. “Restricting transplant options by prioritizing sex matching may also lead to longer waiting times,” they wrote. “Females with a large body size would be particularly disadvantaged by an approach that favoured allocation of sex- and body-size matched kidneys.”
Study co-authors include Bryce Kiberd, MD, Ian Alwayn, MD, and Ayo Odutayo, MD.
Disclosures: The authors reported no financial disclosures.
The article, entitled “Donor-Recipient Absolute Weight and Sex Mismatch and the Risk of Graft Loss in Renal Transplantation,” will appear online at http://cjasn. asnjournals. org/ on March 30, 2017, doi: 10.2215/CJN.07660716.
The editorial, entitled “Donor Quality in the Eye of the Beholder: Interactions Between Non-immunologic Recipient and Donor Factors as Determinants of Graft Survival,” will appear online at http://cjasn. asnjournals. org/ on March 30, 2017.
The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.
Since 1966, ASN has been leading the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients. ASN has nearly 17,000 members representing 112 countries. For more information, please visit http://www. asn-online. org or contact the society at 202-640-4660.
MINNEAPOLIS (KMSP) – Three-year-old London Hall has no problems keeping up with her brothers now, but as an infant it quickly became clear her twin brother was reaching milestones she wasn’t.
“[She was] three months old or so when we first started noticing that maybe when they were laying the floor she wasn’t moving her legs and arm quite as much,” said Gloria Hall, London’s mom.
Later when London struggled to eat and keep food down, her parents learned they were both carriers of a rare gene mutation, which was now preventing London’s kidney from processing proteins properly and she needed a transplant. At 17 months old, London received her mother’s kidney.
“I remember someone saying that you gave life to her twice: birth and then donating a kidney,” said Branden Hall, London’s dad.
London’s story is similar to the many success stories Dr. Srinath Chinnakotla from the University of Minnesota’s Amplatz Children’s Hospital recently researched. He studied pediatric kidney transplants at the U of M going back to the 1960’s and discovered most recently those performed on children under two years old have a 100 percent success rate after one year and five years. That’s better than any other age group.
“When a child has kidney failure and you put them on dialysis, the dialysis only purifies about 10 percent of the blood, so those children don’t develop well,” said Dr. Chinnakotla. “They have growth failure and they have problems in achieving milestones as well. The studies we’ve done at our institution show once you do the kidney transplant, boy, they quickly grow like a weed.”
Dr. Chinnakotla points out the U of M is a longtime pioneer of living donor transplants. He says transplant teams nationwide typically wait until a child is at least two years old. The Halls agree with Dr. Chinnakotla’s philosophy – some kids can’t afford to wait.
“I do feel like there is a little bit of a different connection there, you really would do anything for your kid,” said Gloria.
March 9 happens to be World Kidney Day. According to the National Kidney Foundation, there are an estimated 400,000 people living with kidney disease in Minnesota alone and nearly 9,000 are on either dialysis or the transplant wait list. Doctor Chinnakotla says roughly 10 percent of patients on that wait list are children.
Fifty years ago, 6-year-old Tommy Hoag underwent a kidney transplant. It was February 1967 and pediatric nephrologist Richard Fine, MD at Children’s Hospital Los Angeles (CHLA) thought a kidney transplant was the only option for Tommy who had developed glomerulonephritis following a bout with Scarlet fever.
At that time, kidney transplants had only been performed a few times in children and mostly in twins. The doctors were cautiously optimistic that the transplant would succeed and give Tommy a few more years of life.
This week, Tommy and Dr Fine reunited for a special celebration at CHLA to celebrate the 50th anniversary of the transplant.
Tommy is 56 years old and still has that original transplanted kidney. Dr Fine is professor of Clinical Pediatrics at the Keck School of Medicine of USC.
In the audience for the celebration was 14-year-old Gemma Lafontant, CHLA’s most recent kidney transplant patient. Gemma has chronic kidney disease and received a pre-emptive donor kidney 3 weeks ago.
Let’s Get This Done
Tommy’s donor was his father. In recalling the 1967 operation, Tommy said “I remember being wheeled into the operating room and [my father] was already there and he was happy to see me.”
Tommy added, “My dad was a baseball fan, a die-hard Dodgers fan, and also a Babe Ruth fan. When he saw me, he said, ‘Come on in, Bambino! Let’s get this done!'”
Tommy’s transplanted kidney is, if not the longest, one of the longest functioning live donor kidneys in U.S. history.
Dr Fine commented, “Seeing Tommy here today, seeing how well he’s done for such a long period of time, I think, is one of the highlights of my career. We had no idea 50 years ago that we could accomplish having someone survive with one kidney for 50 years.”
During a press conference, Tommy was asked what the transplant meant to him and he responded, “I’ve lived my life. I’ve played baseball and golfed and went on vacations. Fifty years – there is a lot of stuff to do.”
Glomerulonephritis is a type of kidney disease in which the part of the kidneys that filter waste and fluids from the blood is damaged. It may be acute or chronic (coming on gradually), and may occur on its own (primary) or be caused by another condition (secondary).
General symptoms include Blood in the urine (dark, rust-colored, or brown urine), foamy urine (due to excess protein in the urine) and swelling of the face, eyes, ankles, feet, legs, or abdomen. Abdominal pain, blood in the vomit or stools, cough and shortness of breath, diarrhea, fever and nosebleeds may occur.
Treatment depends on the cause of the disorder, and the type and severity of symptoms. Controlling high blood pressure is usually the most important part of treatment. A procedure called plasmapheresis may sometimes be used for glomerulonephritis caused by immune problems. The fluid part of the blood that contains antibodies is removed and replaced with intravenous fluids or donated plasma (that does not contain antibodies). Removing antibodies may reduce inflammation in the kidney tissues. Patients with this condition should be closely watched for signs of kidney failure. Dialysis or a kidney transplant may eventually be needed.
New research provides insights on transplant recipients’ antibody responses against donor kidneys and how the timing of those responses can have important implications. The findings appear in an upcoming issue of the Journal of the American Society of Nephrology (JASN).
An antibody response against donor organs is the main cause of kidney rejection following transplantation. Antibodies can occur in 2 scenarios: before transplantation (pre-existing donor-specific antibodies) and after transplantation (de novo donor-specific antibodies). Little is known about how these processes compare.
Understanding the role of antibodies in transplant rejection is needed to guide matching of donors and recipients and to better prevent rejection. A team led by Alexandre Loupy, MD, PhD, Olivier Aubert, MD (INSERM U 970, Paris Translational Research Center for Organ Transplantation, in France), and Phil Halloran, MD, PhD (Alberta Transplant Applied Genomics Centre, in Canada) studied 205 patients who experienced antibody-mediated rejection following kidney transplantation: 103 patients had pre-existing donor-specific antibodies and 102 patients had de novo donor-specific antibodies.
There were various differences between patients with pre-existing vs. de novo donor-specific antibodies, but the most striking was the superior kidney survival experienced by the pre-existing group compared with the de novo group (63% vs. 34% at 8 years after rejection, respectively), regardless of treatment.
“Our study highlights that rejection due to antibodies that were present before transplantation is linked with a significantly better outcome that rejection due to de novo donor-specific antibodies,” said Dr. Aubert.
“Our results encourage the transplantation of patients who have antibodies before transplant. These patients would not normally have been considered as good candidates for transplantation and would have stayed on dialysis because of a high level of sensitization that prevents from finding a compatible kidney,” said Dr. Loupy. The findings also indicate the need to closely monitor patients for the development of de novo donor-specific antibodies so that therapies can be initiated to preserve kidney function.
The success of kidney transplants has vastly improved for children over the past half-century, with young children now experiencing better long-term transplant success than adults, according to study results from a large pediatric transplant center. These findings are published online as an “article in press” on the Journal of the American College of Surgeons website in advance of print publication.
“The outlook for infants and children with end-stage kidney disease was once dismal, with poor survival rates after transplant,” said study principal investigator Srinath Chinnakotla, MD, FACS, an associate professor in the Department of Surgery at the University of Minnesota Masonic Children’s Hospital in Minneapolis, where the study was performed. “There has been great progress in pediatric kidney transplantation, and now the patient survival rate is almost 100 percent.”
Compared with the hospital’s one-year survival rate of 97 percent since 2002, only 85 percent of pediatric kidney transplant recipients were still alive one year after their transplant 40 to 50 years ago, the study data showed.
In this new analysis of medical records of 1,056 pediatric kidney transplants performed at the children’s hospital between June 1963 and October 2016, the researchers evaluated differences in rates of patient survival and other patient outcomes between three eras. Era 1 consisted of the early years of pediatric kidney transplantation, 1963 through 1983; Era 2 was from 1984 to 2001; and Era 3 encompassed 2002 to 2016.
Also improved over time is graft survival–continued function of the transplanted kidney–the investigators reported. In the first Era, only 42 percent of transplant recipients still had graft survival at 10 years, a statistic that improved to about 58 percent in Era 2 and 70 percent in Era 3.
“Thanks to advances in immunosuppressive [antirejection] medications including steroid-free drugs, better surgical technique, and improved management of infections after kidney transplant, children ages 10 years and younger now have the best long-term graft survival of all ages,” Dr. Chinnakotla said.
He added that kidney transplant is far less common in infants and children than in adults. Fewer than 720 of the nearly 18,600 kidney transplants performed in 2015 were in patients younger than 18 years, the Organ Procurement and Transplant Network (OPTN) reported.
Living-Donor Kidney Transplants
In this study, two transplant characteristics lowered the risk of graft loss (also called graft failure), which occurs when the donor kidney stops functioning. One characteristic was having a “preemptive” kidney transplant, meaning before the child started kidney dialysis. The other was when the donor kidney came from a living donor rather than a deceased donor. For the latter, the investigators reported the following:
- In the current Era, the 10-year graft survival rate was 78 percent for living-donor transplants compared with 57 percent for kidneys from deceased donors.
- Half of all living-donor transplants in Era 3 are projected to still be functioning (called the graft half-life) at 25 years, whereas half of deceased-donor grafts have a projected survival of 19 years.
- Living-donor graft survival was superior even when the donor was not related to the transplant recipient.
“For children with end-stage kidney disease,” Dr. Chinnakotla said, “kidney transplant is the only therapy that offers them the long-term possibility of a near-normal life, and a living-donor graft is their best option.”
Nationwide, however, fewer young patients are benefiting from living-donor kidney transplant. Among all pediatric kidney transplants, the percentage that were living-donor grafts dropped from 50.1 percent in 2004 to 33.7 percent in 2015, per the OPTN. In the study by Dr. Chinnakotla’s group, the proportion of living donors was higher, at 65 percent in Era 3 but still lower than the 70 percent in Era 2.
“The declining rates of living donation for children are concerning,” he said. “Living donation should be encouraged for all patients with kidney failure, especially small children.”
Recent North American data show that infants do worse than older children do after a deceased-donor kidney transplant. However, in this new study from the University of Minnesota, infants reportedly had outcomes similar to those in older children throughout all three Eras. Dr. Chinnakotla attributed their success to their surgical technique, which he said allows them to transplant adult kidneys into babies and small children; an experienced transplant team; and careful patient monitoring after transplant.
Most of their patients were white, a race known to have better transplant success than blacks. Yet, Dr. Chinnakotla said he believes that Hispanic and black children at their institution also fare better after kidney transplant today compared with years ago.
Reasons for Transplant
The three most common diseases causing kidney failure and requiring a transplant were the same in all three Eras, according to the researchers. These conditions were congenital kidney anomalies (abnormally developed kidneys at birth), obstructive uropathy (blockage by a valve of the passage of urine from the kidneys to the bladder), and congenital nephrotic syndrome (an inherited disorder in which protein develops in the urine and the baby’s body swells).
Causes of death of pediatric transplant recipients did change over the years, as reported in the article. In Era 1, the primary cause of death was infection, which Dr. Chinnakotla said rarely causes post-transplant death today because of advances in infection prevention and treatment. In Era 3, children were most likely to die of sudden unknown causes in the first year after transplant, and after the first year, due to motor vehicle crashes or other types of trauma.
Some Improvements Needed
Some challenges remain in pediatric kidney transplantation nationwide, according to Dr. Chinnakotla. Compared with younger children, patients ages 11 to 18 years have greater odds of their new kidney failing (1.4 times the odds of younger children in their study). Preteens and teens tend to have worse results after transplant largely because they are more likely to not adhere to taking their medications as instructed, he said.
Another problem is sensitization, in which harmful antibodies develop after transplant that attack foreign tissue and make the body more likely to reject another kidney transplant. In other patients, kidney disease can recur after a transplant.
“These [problems] all deserve our special attention if further progress is to be made,” the authors wrote in their article.
Kristi’s Kids has some promising news about a Tucson girl, with serious medical issues. She’s not letting anything get her down, or hold her back.
Stephanie Roat,13, has been through a lot in her young life, and she’s preparing for, perhaps, her biggest challenge yet. All the while, she’s hoping to inspire others to have strength too.
Stephanie is no stranger to surgery. In fact, she’s had five. That’s more than most people have in a lifetime.
“She was born at 28-weeks, and she was only one-pound, 12-ounces when she was born,” Stephanie’s dad, James Roat, told Kristi’s Kids.
Stephanie spent the first three months of her life at Phoenix Children’s Hospital. She was born with one kidney, and a bladder that didn’t develop properly. Doctors say she needs a kidney transplant.
“Things come up, and you kind of have to adjust, and roll with it and then there’s just, we like to say ok it’s the new normal,” Stephanie’s mom, Karen Roat, told Kristi’s Kids.
Stephanie just learned her cousin is a donor match. The family’s bond has never been stronger; neither has their faith.
“We definitely believe that’s what saved her, and brought her through, and helped her get through all this,” James told Kristi’s Kids.
Stephanie is like most 13-year-olds. She enjoys spending time with her big sister, and living life to the fullest.
“I like to play video games a lot. It helps me to de-stress with everything going on. I like to do theater, to sing and dance and act,” Stephanie told Kristi’s Kids.
The road ahead is long and bumpy, but Stephanie stays strong, and wants other kids to do the same.
“Don’t even think of it as it defines you. It doesn’t define you. It just a part of your life, and it isn’t you,” Stephanie said.
For now, Stephanie is focused on the immediate future. Her mom is a teacher, and dad is a Pima County Sheriff’s sergeant, but Stephanie isn’t sure what she wants to be yet.
I’m young, so I have a lot of life ahead of me to figure it out,” Stephanie told Kristi’s Kids.
As you might expect, the Roat’s expenses are piling-up. You can help by checking out Stephanie’s GoFundMe page by clicking here.
MADISON, Wis. – Doctors said a 4-year-old girl who underwent a lifesaving transplant Wednesday received the “perfect kidney” from her donor, with whom she shares a special connection.
News 3 first told you about Lyla Carreyn and her need for a kidney transplant last September.
She has a rare autoimmune disorder that caused her kidneys to fail.
A nationwide search for a suitable donor turned up nothing, but her perfect match ended being right next to her in a Madison preschool classroom.
Her teacher, Beth Battista, surprised the family last fall, saying she would donate her kidney to Lyla.
On Wednesday, the two underwent surgery.
“It’s such a joyful day,” Lyla’s mom, Dena Carreyn, said. “We’re so thankful for the gift that Lyla is getting and hoping that this is a fresh start and hoping it is the miracle we’ve been waiting for.”
Battista was out of surgery and doing well Wednesday afternoon.
Carreyn posted on Facebook on Wednesday night, saying Lyla was out of surgery and resting comfortably.
“We’re incredibly relieved and grateful that today’s surgeries went smoothly,” Carreyn said on Facebook. “Fingers crossed for an easy, restful night for both Lyla and Beth.”
Teacher, student kidney transplant…
MADISON, Wis. – After a year-and-a-half long mission to save the life of 4-year-old Lyla Carreyn, is nearing an end.
On Wednesday morning, doctors at the American Family Children’s Hospital will give the little girl a life-saving kidney transplant.
“I can’t wait to see all of the milestones she gets to have now,” says Beth Battista, Lyla’s living donor.
A year and a half ago, Lyla became sick at school and her mother, Dena Carreyn, took her to urgent care.
Within minutes, they found themselves in an ambulance and a difficult journey in life.
“Within 15 minutes we were in an ambulance and on our way to Children’s Hospital. The ambulance driver radioed in that they had a 3-year-old in renal failure and that was the first time I knew it was very serious,” says Carreyn.
A nationwide search for suitable kidney donor turned up nothing.
What they didn’t know was the perfect match was sitting across the table from Lyla at school–her teacher.
Battista saw a post on Facebook asking individuals to consider being tested to find a donor match for Lyla.
“Something immediately inside me just said that I need to call in,” says Battista, who tests showed was a match.
“It is a miracle. She was put in my classroom and I was put at this school and it was meant to be,” says Battista.
Lyla was admitted to American Family Children’s Hospital today in advance of Wednesday’s transplant.
But she didn’t get there without some challenges. Last week, she was admitted to the hospital with an infection.
“The last four or five days have been a nightmare,” says Carreyn.
Fortunately, doctors were able to treat Lyla, get her better so she could be cleared for the transplant.
For her mom, the transplant represents a chance her daughter to realize a dream.
“Maybe to see her go to college, maybe see her get married, see grandkids,” says Carreyn.
“To get to have that dream back for her is really huge.”
To learn more about becoming a living donor, visit: www.uwhealth.org/livingdonor.
To become a registered organ donor visit: www.donatelifewisconsin.org