For Organ Transplant Week 2019, we take a look at a study running at Guy’s and St Thomas’ looking at an innovative technique that flushes blood around a kidney before it’s transplanted. Mr Chris Callaghan is a consultant transplant surgeon at Guy’s and St Thomas’ leading the study on Ex-vivo Normothermic Perfusion (EVNP).
EVNP involves flushing blood around a kidney just before it is transplanted into the patient. A similar technique is currently used in heart and liver transplants. We are excited about the potential of this technique to help us reduce the stress and impact of a kidney transplant for our patients, and potentially broaden the pool of donor kidneys that we can transplant.
The technique was developed by surgeons at the University of Cambridge, and we are one of four centres around the UK taking part in a study testing out how it works in practice. The study aims to understand what benefit, if any, this technique brings to patients, and how we should be using to get the most out of it.
One of the aspects we are looking at is whether the technique can ‘test out’ how the kidney is working before it is transplanted. Flushing blood around it shows whether the blood flows through the kidney properly and whether it’s producing urine.
If a kidney transplant doesn’t start working, a patient has been exposed to all the risks associated with surgery for no benefit to them. We then have to put that patient back on dialysis and consider another transplant. So before we transplant, we want to be as sure as possible that the kidney will actually work.
This test could also have the benefit of broadening the donor pool. With deceased donors, we want to make sure the kidney hasn’t been too damaged to be transplanted. We sometimes reject kidneys and it might be that this test could show kidneys can be used that might have been unnecessarily turned down for transplantation with previous techniques. We are also testing out whether flushing the blood around the kidneys might even improve the quality of the donated kidney.
The other exciting aspect for us is whether the EVNP technique might ‘kick-start’ the kidneys and make them work earlier.
When we transplant a kidney from a deceased donor, it can take a few days or even weeks for the kidney to start working again once it’s been transplanted to a patient. This can be really nerve wracking for the patient, and the team taking care of them. If this technique can get kidneys working earlier, that could save the patient a lot of stress, reduce the amount of time they are on dialysis, and reduce the amount of time they have to stay in hospital.
We are not completely sure what the benefits of EVNP might be, so our patients taking part in this study are helping us to push the boundaries of transplant medicine. We hope that the study will help us find the best way to treat our patients in the future.