St. Michael’s Hospital is the first in North America to have used a novel device that cleaned the blood of a kidney patient and allowed him to receive a transplant from a donor with a different blood type.
Andre Cossette, a Grade 4 teacher at Ange-Gabriel Elementary Catholic School in Mississauga, Ont., was on dialysis for three years before undergoing plasmapheresis at St. Michael’s. He then received a kidney transplant from his brother, who has Type AB blood, even though Cossette has Type A blood.
Plasmapheresis separates plasma from a patient’s blood, and runs it through an immunoadsorbent column containing synthetic carbohydrate beads that trap the blood group antibodies. It removes only the anti-A or anti-B antibodies, sparing the other antibodies. The washed plasma is then returned to the patient’s body.
St. Michael’s was the first hospital in North America to perform plasmapheresis using a device known as the Glycosorb ABO, developed by Glycorex Transplantation, a Swedish company, and approved by Health Canada last year. It has been used once in Canada for a heart transplant in Alberta, but this was the first time for a kidney patient. The device is used in 21 countries, mainly in Europe, for kidney, liver, heart, lung and stem cell transplants.
“I get to get my brother’s kidney,” Cossette said, shortly after beginning the first procedure, which lasted about four hours. “I won’t have to be on a waiting list, waiting for a call to come to the hospital within four hours because there may be a kidney available.”
Cossette underwent the procedure a second time before his transplant. He must also take immunosuppresent medications.
Dr. Jeff Zaltzman, director of the hospital’s kidney transplant program, said the procedure could expand the number of living organ donors. More than one-third of potential live donors are turned down because their blood types are not compatible with the person to whom they wish to donate their kidney.
“Every time you have a living donor, you’re helping someone who would otherwise be on a transplant waiting list for a long time,” Dr. Zaltzman said. “That’s also one more person who is not taking an organ from a deceased donor, which could then be given to someone else.”
Dr. Zaltzman headed the transplant team that also included Dr. Katerina Pavenski, a hematologist, and Dr. Ramesh Prasad, a transplantation nephrologist at St. Michael’s Hospital.
The hospital hopes to perform another five or six of these procedures over the next year, depending on patient and donor suitability.
In Ontario, 1,075 people are on a waiting list for a kidney transplant, according to the Trillium Gift of Life Network. The average wait time for a deceased donor kidney transplant is about 4-1/2 years (1,698 days, to be exact).
In contrast, a kidney from a live donor can be transplanted within three months of the completion of the donor’s medical workup. A kidney transplant from a live donor is expected to function for 15 to 20 years, about five to 10 years longer than one from a deceased donor.
The Renal Transplant Program at St. Michael’s began in 1967. The hospital is one of only two in the Greater Toronto Area that performs adult kidney transplants. More than 2,000 kidney transplants have taken place at St. Michael’s, about 130 a year. There are about 350 patients on the hospital’s deceased donor list and about 50 patients in various stages of evaluation for living kidney donation.
St. Michael’s has a long history of innovation in kidney transplantation. In 2000, surgeons at St. Michael’s perform Ontario’s first live-donor kidney retrieval using minimally invasive surgery.
The hospital also has an extensive kidney research program.
Dr. Jeffrey Perl, a nephrologist at St. Mike’s, recently published a paper in the Clinical Journal of the American Society Nephrology, that found patients who must return to dialysis after a kidney transplant failure survive just as well on peritoneal dialysis as hemodialysis, but few choose that option.
Another paper by Dr. Perl in the Journal of the American Society of Nephrology reported the use of central venous catheters may explain the higher death rate in kidney patients on hemodialysis compared to those on peritoneal.
Dr. Darren Yuen wrote in the same journal that early-outgrowth endothelial progenitor-like cells (EPLCs) work better in patients who undergo dialysis at home during the night than those who undergo standard daytime dialysis in a hospital, according to Dr. Darren Yuen, a nephrologist.
He found that EPLCs from patients receiving home dialysis promoted new blood vessel growth better than EPLCs from patients on standard hospital dialysis.