Breaking Barriers: St. Paul’s performs B.C.’s first kidney transplant between people of different blood types

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For 15 years, Steve Waddington had polycystic kidney disease, a genetic condition that can eventually destroy a kidney. Though his kidneys had not yet failed, the 41-year-old longshoreman knew he faced a life on dialysis unless he received a kidney transplant.

His wife, Lori, was willing to give him a kidney, but their blood types were incompatible: he was an O and she was an A. They weren’t alone: an estimated 20-30 per cent of patients eligible for a kidney transplant have potential living donors that are blood-group incompatible.

Waddington registered with BC Transplant but ruefully observes, “There aren’t a lot of people lining up to donate their body parts.” The couple also registered with the Living Donor Paired Exchange Program to potentially “swap kidneys” with other pairs who were facing similar incompatibility issues, but there were no matches.

Then, Steve got a call that changed his life. St. Paul’s was embarking on ABO incompatibility transplantation – performing transplants between patients and donors who are of different blood types.

Pioneered in Japan and the U.S., ABO-incompatible transplantation has had “outcomes that are equivalent to conventional compatible transplantation,” says Dr. Jagbir Gill, a transplant nephrologist at St. Paul’s Hospital and the first Chan Family Scholar.

Though the procedure had never been tried in B.C., its good track record elsewhere convinced Gill that it would benefit patients here.

For Waddington, the call offered him a chance to be the recipient of the St. Paul’s Hospital Kidney Transplant Program’s first ABO-incompatible kidney transplant, and he jumped at it. He was young and, because he didn’t have any other complicating conditions such as diabetes or heart disease, he was a good candidate for the procedure. There was another reason he was an ideal patient. His wife, Lori, had the Type A subgroup that is more compatible with O-Types.

To allow his body to accept a kidney of a different blood type, Waddington needed to take strong immunosuppressive medications and undergo plasmapheresis, a dialysis-like procedure which removes antibodies from his blood, including those that would destroy a new kidney.

Before the transplant operation, Steve had to have his blood antibody levels measured. Once a baseline was established, the plasmapheresis was repeated several times over a two-week period beginning at the end of June 2009. By July 8, all of his antibodies had been removed and he was able to receive Lori’s kidney during a seven-hour procedure. After the operation, the plasma exchange was repeated to keep the antibody levels low.

“By keeping the levels low for a month after the operation, we can prevent rejection, even when the antibodies return to normal levels later,” says Gill. “It is surprising and remarkable.”

After five days in hospital, Waddington returned home. Five months later, he was back at work. He takes immunosuppressant drugs, just as any post-transplant patient would. “I feel great – better than before,” he says.

Until recently there were few options for people like Steve. Now, if people don’t have a compatible loved one who can donate, there are two possibilities at St. Paul’s Hospital – the Living Donor Paired Exchange Program and ABO-incompatible transplantation.

St. Paul’s performs 45 to 50 live kidney transplantations a year. With these new options, Gill believes that number could exceed 65 a year. “It’s exciting,” he adds.

Waddington was delighted with the care he received at St. Paul’s: “Everyone from the doctors to the orderlies was good to me.”

Towards Lori, he feels immense gratitude: “She saved our family.”