No kidney left behind: reviving kidneys for transplant
New research suggests it could now be possible to revive and recondition kidneys for transplant that might otherwise be discarded.
The UK kidney transplant waiting list is already around 5,000 people long yet only 3,200 transplants happen each year. People can wait years for a life-saving kidney and, sadly, five people die every week while waiting for that kidney. To give everyone the chance to receive a transplant, doctors have to consider kidneys that may not be in an ideal condition. While these 'marginal kidneys' are generally fine, it is possible these organs will not work as well as an ideal kidney would.
A team led by Newcastle University researcher Dr Emily Thompson may change that. Emily’s research is funded by Kidney Research UK and by the NIHR Blood and Transplant Research Unit.
Using human kidneys in the lab and a technique called normothermic machine perfusion (NMP), combined with a stem cell treatment, Emily was able to improve how well marginal kidneys work. This research could one day improve the number and quality of donated kidneys.
The kidney shortage
Transplant remains the best treatment for patients with kidney failure. But too many people never receive this treatment because there is a shortage of suitable organs. Even when kidneys do become available, many are classified as 'marginal'.
Sometimes, people receiving these organs can have post-transplant problems, and may need a second transplant later in life. Because of this, marginal kidneys aren’t used often. Yet marginal kidneys could help bring down transplant waiting times.
Reviving and reconditioning marginal kidneys could give them a new lease of life.
The first step in this revival process is to get life-giving oxygenated blood flowing through a donated kidney. NMP, a technique pioneered by Professor Mike Nicholson that we're proud to say we helped fund some of the earliest research on, does just that.
Before a kidney is transplanted into a patient, NMP pumps oxygenated blood through the organ at body temperature. It keeps a kidney working after it's removed from the donor and helps to avoid something called reperfusion injury.
With the kidney outside the patient, and being pumped with blood, there's a fantastic opportunity to treat the kidney, without affecting the patient. Emily found that treating kidneys with a type of stem cell called Multipotent Adult Progenitor Cells (MAPC®) led to several improvements caused by the release of anti-inflammatory molecules – inflammation levels and the amount of injury to the kidney both went down – this improved blood flow to damaged cells leading to increased urine production.
Emily said, “This work has completely changed our thinking as it shows that we can pre-treat the kidney directly, instead of treating the whole patient before or after their transplant. This opens up exciting opportunities to explore other therapies that would improve the donor kidney, such as gene therapy or other stem cells, and we are moving our research forward and looking at a lot of other drugs and therapies.”
Emily and her team are the first to show that NMP can deliver stem cell therapy directly into an organ to revive and repair damaged kidneys before transplantation.
This work here is revealing new ways to make marginal kidneys more suitable for transplant. Work like this could offer hope to people with kidney disease, shortening transplant waiting lists and reducing the need for dialysis.
“This exciting research shows that stem cell treatment could improve the quality of donor kidneys,” said Dr Maria Tennant, Head of Communications at Kidney Research UK. “Right now, there are not enough transplants available for everyone who needs one, and a transplant doesn't last for life. We hope this treatment ultimately means more kidneys become fit for transplant and are able to last much longer.”
The next step is to take this into clinics to find out if these reconditioned kidneys result in better and longer transplants. Emily will continue to lead on this exciting work with further research and testing and we hope to see clinical trials within a few years.
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