Rare 5-way kidney swap transplant successful

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Apr 5 2011

All ten patients are doing well after a rare 5-way kidney swap transplant at California Pacific Medical Center in San Francisco, part of the Sutter Health network.

The surgery, which took place Friday, April 1, was the first single-hospital 5-way kidney swap transplant in California and only the second in the U.S. Usually these kinds of complex swaps involve multiple medical centers rather than just one. The day-long string of surgeries began shortly after 7 a.m. and the last procedure finished around 5.30 p.m.

"This was an incredibly complex procedure from both a surgical and logistical perspective," says William Bry, M.D., Surgical Director of CPMC's Kidney Transplant team and the lead surgeon in the procedure. "It involved 5 surgeons, 4 anesthesiologists, ten nurses in the Operating Room, plus 40 support staff all of whom played an important role in ensuring this was possible. All in all it was an extraordinary team effort to make this happen as successfully as it did."

"It means my life will never be the same," says April Langstraat, one of the patients. "I am going to get a new kidney, and a whole new life. There are just not enough words to thank the person donating the kidney for what they are doing. It's just an amazing gift."

The five couples involved in the procedure come from Northern California and the Central Valley. Each couple included a patient in need of a kidney, and a spouse, partner or friend who volunteered to donate their kidney but who was not a match. In the past, that often meant that the patient would have to find another donor who was compatible, or wait for a kidney from a cadaver. However, a sophisticated "cloud-based" computer program has changed that and enabled these five donors to be able to give their kidney, knowing their partner was going to get one in return.

The program, called Silverstone Matchgrid, takes the individual characteristics of all those involved and then generates a series of matches in which each donor is matched with a transplant candidate who they don't know but who is compatible with the kidney being given up.

Matchgrid was created by David Jacobs, who came up with the idea after himself undergoing a kidney transplant at CPMC. He realized that there were many potential donors who were in effect being lost to the system because they didn't match their friend or loved one. "Having almost died because of a lack of available kidneys, I wanted to do something to try and reduce the likelihood that would happen to other kidney patients," says Jacobs.

The good news for donors is that giving up a kidney is unlikely to have any long-term impact on their health.

"It's clear from research that healthy living donors don't have any change in their life expectancy after giving a kidney," says Steve Katznelson, M.D., Medical Director of CPMC's Kidney Transplant Program. "In fact, there may even be an improvement in the quality of life for donors because they get to see just what a big impact their gesture is having on the life and well-being of their friend or loved one. Without a living donor, these recipients would have to wait on the list for an average of between 3 to 5 years. In some cases they may never get a second chance at life."

There are an estimated 83,000 people in the U.S. waiting for a kidney transplant, 16,000 in California alone. To try and address the shortage CPMC has joined the federal government's Kidney Paired Donation (KPD) program and has also been working with the National Kidney Registry, a web-based system involving dozens of transplant centers around the country.

"The purpose of these partnerships is to eventually make KPD available to as many transplant centers and patients as possible," says Dr. Katznelson. "It's estimated that around 6,000 people could qualify for a paired donation if they knew of this option. An efficient, national KPD effort could result in 2,000 to 3,000 additional living donor kidney transplants annually. Also, the more patients that are registered for KPD, the greater the likelihood of finding additional matches."

Finding matches for patients on the KPD list has another benefit too. By moving these patients off the national waiting list for a cadaver kidney it allows other patients on the list to move up higher, and increase their chance of getting a kidney.