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Blood type incompatibility no longer barrier to kidney donation

Blood type incompatibility no longer barrier to kidney donation

As far as organ failure goes, those whose kidneys have quit working are fortunate as dialysis can replace the function of the kidneys.

However, it is a lifelong treatment for patients with end-stage kidney failure, requiring the majority to visit a haemodialysis centre three times a week for three to five hours each time to receive the treatment.

Others may opt for peritoneal dialysis, which is done on a daily basis for one to two hours by the patient themselves.

While patients can live a relatively normal life on dialysis, it is not the best solution to their condition.

Ideally, they should receive an actual kidney via transplantation from a living or dead donor, to replace their own.

Says consultant nephrologist Datuk Dr Tan Si Yen: “A transplant is a better form of treatment in terms of survival and quality of life.”

For example, according to the latest Report of the Malaysian Dialysis and Transplantation Registry in 2016, the 10-year survival rate for kidney transplant patients is 71%, compared to 27% for dialysis.

It also notes that there were nearly 40,000 patients on dialysis as of Dec 31, 2016.

Of these, Dr Tan, who heads the nephrology and renal transplant services in a private hospital in Kuala Lumpur, believes that the majority are medically fit for transplant.

However, according to the Report, while the number of patients on dialysis has been increasing steadily from 17,097 in 2007 to 39,711 in 2016, the number of kidney transplants has remained about the same.

In the decade between 2007 and 2016, the number of new kidney transplants ranged from 82 (2016) to 141 (2009). This includes those who went overseas to countries like China and India for their procedures.

Comments Dr Tan: “Our transplant programme here is so weak that the patients have no choice but to go overseas, and I would think about half go overseas.

“They either have no relatives who can donate, or if they have relatives, they’re not suitable – they don’t pass all the tests.”

He notes that in Malaysia, kidney donations are only allowed from relatives or anonymous brain-dead organ donors (also known as cadaveric donors).

“The cadaveric transplant rate is very low – we sometimes don’t even talk about it because it’s almost non-existent (only nine people, or 11%, received a cadaveric kidney in 2016, although 51, or 47.2%, received one in 2015).

“So, the majority of transplants are living transplants, which means, by default, they are from relatives, because we don’t allow unrelated living donors, except for spouses,” he explains.

However, he adds that one-third of potential living donors are rejected because of blood group incompatibility.

Kidney transplant, kidney donation, kidney failure, dialysis, ABOi kidney transplant, blood type incompatible kidney transplant, orgna donation Malaysia, Star2.com

In Malaysia, those in need of a kidney transplant can only receive them from first or second degree relatives (parents, children, siblings, grandparents, grandchildren, aunts, uncles, nieces, nephews, first cousins and half-siblings), spouses or cadaveric sources. Donors who wish to give their kidney to someone unrelated or a relative beyond the second degree need to be evaluated by the Health Ministrys Unrelated Transplant Approval Committee. — Filepic

Dealing with antibodies

All humans have one of four blood types: A, B, AB or O.

These are classified according to the type of antigen expressed on the individual’s red blood cells (RBCs).

You are type A if your RBCs have antigen A; type B if your RBCs have antigen B; type AB if your RBCs have both antigens A and B; and type O if your RBCs have neither antigen A nor B.

Similarly, your immune system will express the antibodies opposite to the RBC antigens that you have, i.e. you will express antibody B if you are type A; antibody A if you are type B; neither antibodies if you are type AB; and both antibodies A and B if you are type O.

This is because antibodies will seek out their compatible antigens – i.e. antibody A and antigen A, or antibody B and antigen B – and destroy the red blood cells.

As organs also express ABO antigens, it is crucial to ensure that the donor does not have antigens that are compatible with the recipient’s antibodies. Otherwise, the antibodies will destroy the donated organ.

However, the last three decades have seen the development of a procedure that enables blood group incompatible, or ABOi, organ transplants, including the kidney.

Having seen one too many cases of potential donors turned away because of blood-group incompatibility in his practice, Dr Tan, in what he describes as “a moment of madness” seven years ago, decided to pioneer ABOi kidney transplants in Malaysia.

Basically, the patient, or kidney recipient, has to undergo a “desensitisation” protocol, where their ABO antibodies are removed.

After a lot of research, adaptation and discussions with foreign colleagues who have preformed the procedure, Dr Tan came up with a protocol that begins with the patient starting on rituximab, which suppresses the activity of the spleen, about a month before the transplant. This as the spleen is an important source of antibodies, he explains.

The critical component of the protocol is plasmapheresis, which is a procedure that removes antibodies from the blood plasma.

The patient undergoes this procedure on alternate days for two weeks prior to the transplant.

At the same time, the patient receives immunosuppressive drugs to help keep their antibody levels down.

“Once the antibodies are low enough to prevent rejection, I have a very short window of opportunity to go in and perform the transplant, otherwise there is a rebound of the antibody levels,” Dr Tan explains, adding that this period is 24 hours.

The transplant itself and the post-operation treatment is similar to a standard kidney transplant.

While the main risk for the procedure – aside from rejection of the new kidney – is that of infection, which is highest during the first three months after the operation, this is similar for regular kidney transplants as those patients also have to take drugs to suppress their immune system.

Dr Tan notes that due to the extra procedures involved, the cost of an ABOi kidney transplant is double that of a regular kidney transplant.

Donor requirements

Kidney transplant, kidney donation, kidney failure, dialysis, ABOi kidney transplant, blood type incompatible kidney transplant, Dr Tan Si Yen, Star2.com

Dr Tan is very proud that their patient survival rate for the ABOi transplant procedure at five years is 100 with 11 cases under their belt to date. — AZMAN GHANI/The Star

Meanwhile, the most important requirement for the donor is that they must be both physically and mentally healthy.

They will be required to go through a series of tests and evaluations to ensure their health status.

Aside from checking their blood type, the donor’s human leukocyte antigens (HLAs) are also compared to the recipient’s.

As HLAs can also trigger an attack by the recipient’s antibodies, the more similar they are between the donor and the recipient, the better the chances of success.

However, Dr Tan notes that this is not as crucial in the ABOi procedure as long as the recipient does not have antibodies against the donor’s HLA antigens.

“If there are HLA antibodies, they can also be removed by plasmapheresis,” he says.

The donor will also be checked for infectious diseases like HIV and hepatitis, certain non-communicable diseases like diabetes, heart disease and cancer, and their kidney function.

In addition, the transplant team will evaluate the donor to ensure that they are mentally healthy and fully aware of the risks and benefits of their decision.

“Once they pass all the tests, they should be okay to lead a normal lifestyle (after the transplant),” says Dr Tan.

“They should be healthy enough to continue working; if they are young, they should be able to start a family; and even if they are old, it should not compromise their longevity – they should continue to progress well.”

To date, Dr Tan and his team have performed 11 ABOi kidney transplants, all successful with all donors and recipients still currently healthy and functioning well.

He notes that the programme was launched and maintained without any funding or technical support from external sources – a feat he is proud of as even in developed countries, only certain medical centres can perform the procedure.

“In addition, our success led to Hospital Kuala Lumpur and University Malaya Medical Centre trying to set up their own ABOi transplant programmes,” he says.

“We hope that by our success, we will be able to help reduce the workload and the expenses of public hospitals, as many patients have insurance or can afford it themselves.

“Because the transplant rate is so low, we hope that our programme will help to contribute to the transplant rate and make it less necessary for patients to go overseas,” he adds.

Age is no barrier to kidney donation if you are healthy

Age is no barrier to kidney donation if you are healthy

When Simah Empaling heard her child was gravely ill from kidney failure in 2012, she went on a hunger strike. She badly wanted to see her daughter, Ibi Uding, who was on dialysis.

Simah lives in Kampung Merakai, Serian, a village about 85km from Kuching, Sarawak, while Ibi was then in Kuching.

Alas, none of her other children were willing to take her to the hospital for fear that she might not be able to withstand the pain of seeing Ibi suffer.

So she refused to eat.

Eventually, Simah made the journey and broke down when she saw a pale Ibi in the ward, hooked up to a machine.

Ibi, 56, recalls: “She hugged me and cried, saying she could not allow her child to die before her. She kept asking what she could do to help.

“By then, I was constantly vomiting, urinating blood, giddy, couldn’t eat or drink, and had lost more than 15kg.”

Ibi had been diagnosed with polycystic kidney disease, an inherited disorder in which clusters of cysts develop primarily within the kidneys, causing them to enlarge and lose function over time.

“The symptoms started in 2007 with blood in the urine and a bloated stomach. If I carried heavy objects, I’d have back pain.

“I didn’t think much of it because I had three teenage kids and was busy running a business with my husband.

“I must admit that my diet wasn’t the best either,” says the former PKR Sarawak Wanita chief, who is saluted as the Iban torchbearer in her relentless fight for their rights.

As organ transplants involving non-relatives are not allowed in Malaysia and none of her other relatives were a compatible match, Ibi was in dire straits.

Then Simah offered to donate her kidney.

Initially, the doctors were hesitant as she was 79 then. However, Simah passed all the medical tests necessary for a kidney donor with flying colours.

“Prior to the transplant, my grandmother had never been admitted to hospital except when she delivered her six children.

“Her lifestyle is healthy as she used to plant padi and corn in the kampung.

“She also loves fishing, but we had to stop her because she cannot hear well anymore. We’re afraid she might not be able to hear the motorboats,” relates Ibi’s daughter, Seraphina Shantee, 26.

The adorable Simah chips in while Seraphina translates: “My late husband taught me how to fish, but now my children won’t let me go to the river.

“I used to be a strong rower, but I don’t have the same strength anymore.”

The only hitch was that Simah and Ibi were of different blood types.

Fortunately, consultant nephrologist Datuk Dr Tan Si Yen and his team were able to perform blood group incompatible, or ABOi, kidney transplants – the first in Malaysia to do so.

Thus, Simah became the oldest living kidney donor in South-East Asia.

Following the transplant, the doctors were amazed that Simah’s kidney functioned like it belonged to a 40-year-old.

She was out walking within three days of the operation, while it took Ibi a longer time to recover.

The first 100 days were crucial and Ibi adhered strictly to her doctor’s advice, although she contracted urinary tract infections twice.

It has been six years since the transplant was performed and the duo are doing well. They only have to go for check-ups annually.

Seraphina says: “My grandma has not fallen sick since. She needs assistance to walk and might complain from a bit of joint pain now and then, but that’s it.

“She doesn’t even have scars from the surgery. Her skin has healed so well.”

Simah, 84, lives alone in the village (her son lives next door) and continues to enjoy what life has to offer.

“From young, I eat only fish or chicken, and plenty of vegetables. I cook daily, mop and clean the house. I wake up at 8am and hand wash all my clothes,” she says.

Occasionally, Ibi, who now lives in Kuala Lumpur, will fly her mother over for a holiday.

“But she finds it boring here because we’re all at work. She will go knocking on people’s doors and make conversation with them.

“And because she can only speak Iban, the neighbours think she is a crazy woman and complain to the management!” says Ibi, laughing.

“One time we were in Kuching and I told her to stay downstairs while I went upstairs to take a shower.

“When I came down, I found the gates open, the air-conditioners and all lights switched on!

“She was sitting on the sofa and looking at me innocently. She has a curious nature and will turn on buttons to test what happens.”

Simah flashes me her warmest smile, oblivious to our discussion.

“Grandma is such a loving and caring person,” Seraphina adds.

Choking with emotion, a teary Ibi says: “I don’t know what I would have done without her. She’s proven that it’s never too late to donate a kidney. She’s been amazing… my saviour.”

Tina Turner reveals husband gave her kidney for transplant

Tina Turner reveals husband gave her kidney for transplant

Tina Turner has revealed that she underwent a kidney transplant with an organ donated by her husband.

The 78-year-old singer says in an upcoming autobiography that she has suffered from kidney disease, and by 2016 her kidneys were at “20% and plunging rapidly.”

She says her husband, Erwin Bach, “shocked me by saying that he wanted to give me one of his kidneys.” Turner says she was “overwhelmed by the enormity of his offer.”

Turner writes that afterward she felt “happy, overwhelmed and relieved that we’d come through this alive.”

Turner, whose hits include Proud Mary and What’s Love Got To Do With It?, married German music executive Bach in 2013 after a long relationship.

Extracts from Tina Turner: My Love Story were published recently in the Daily Mail newspaper and released by its UK publisher Penguin Random House. The book is published in Britain and North America later this month.

In the book, Turner encourages people to sign up to donate organs in order to save lives.

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