“Gift of time” could enable nearly 100 more kidney transplants each year

• Kidney Research UK says that a new method of preserving donated kidneys could offer hope and the “gift of time” to save kidneys from being discarded

• The charity reveals that nearly 100 kidneys a year are not transplanted after retrieval as they are deemed clinically unviable

• Kidney transplant waiting list of 5,000 could be reduced through this new method

London 26 September 2022: Kidney Research UK has today revealed that around 100 kidneys could potentially be saved for transplant each year after being retrieved from donors. The charity looked at three years of data from NHS Blood and Transplant to determine the number of kidneys deemed clinically unsuitable for use. However, a new technique to better preserve kidneys before surgery could extend their viability and increase the number of kidneys available for transplant.

The findings come as the charity marks Organ Donation Week – a time typically used to spread awareness around the benefits and impact that transplantation can have.

Sandra Currie chief executive of Kidney Research UK explained: “Patients wait on average over a year and a half for a kidney transplant, some wait much longer and when they do receive the call, they can face a very difficult and tense time involving an urgent journey to the hospital to avoid the risk of missing out on a life-changing organ. Unfortunately, we know of many patients who have been called to hospital multiple times, only to be told the donor kidney cannot be used after all. One important reason for this is the very short time available currently to keep the kidney in good condition ahead of the surgery to transplant it. The research that we are funding aims to extend this critical window of opportunity from retrieval to transplant.”

With funding from Kidney Research UK, Dr John Stone and Professor James Fildes from Pebble Biotechnology Laboratories in Alderley Park, Macclesfield, have made significant progress in keeping retrieved kidneys viable for longer. Their research uses normothermic perfusion, in which oxygenated blood is pumped through a kidney to simulate the flow of blood within an organ. Cold storage of the kidney is currently the standard method, but the longer the organ is on ice, the greater the chances of damage to the kidney. Perfusion could offer a solution to storage that does not impact the viability of the organ.

Current guidelines advise that perfusion should only be used to test the function of the kidney, ideally for less than three hours before the procedure causes injury to the organ. However, in an experimental setting, the team have developed a new protocol using ethically sourced pig kidneys, without evidence of injury at 24 hours. The team are now trying to extend perfusion into days.

Inspiration for the project came from John’s 11-year-old nephew, Luke, who received a kidney transplant from his own father in May this year. With the average transplant lasting for up to twenty years, John understands that Luke will probably need at least one more in his lifetime, meaning that his work could be crucial to giving his nephew a better outcome in the years ahead.

Dr John Stone, Senior Scientist at Pebble Biotechnology Laboratories said: “The clock is ticking as soon as you remove a kidney from a donor, you have a short amount of time before the organ is no longer viable. Transplant centres are under immense pressure to ensure the organ is not wasted but face operational challenges such as a lack of resources and sharing operating theatres with other departments, meaning that despite their best efforts, surgeons simply run out of time. So far, we have been able to keep a kidney on the perfusion circuit for twenty-four hours without causing damage. With current guidelines advising just three to six hours of perfusion, our methods could allow more time so more patients receive their life-saving transplant and fewer precious organs go to waste.”

The team believe that their methods could be adopted in a clinical setting within the next three years, directly addressing some of the logistical and operational issues across many NHS transplant settings.

John and the Pebble team are determined to push the boundaries of perfusion, not only to ensure every organ can be transplanted, but also to enable the development of new innovations, including genetic modification with gene therapies, the creation of synthetic blood cells, and novel immunomodulators that could prevent rejection.

Case study – Sanjay Mistry: Sanjay’s story sounds like a worst-case scenario but is an unfortunate reality for many people with kidney disease. After racing to hospital for a transplant twice, it was only on the third call from the transplant team that he was able to finally get his life back.

Living with diabetes since his early twenties, Sanjay’s kidney journey began just five years ago after falling ill at a wedding. He spent eighteen months on dialysis, with his nephrologist informing him that he could wait up to two years or even longer for a new organ.

In 2019, he received the call he’d been waiting for and picked up the phone in a daze at 3am. Sanjay was rushed to Addenbrooke’s Hospital, Cambridge but after spending over 24 hours waiting, he was given the devastating news that the organ was no longer viable.

Sanjay explained: “The waiting is torturous and is something that they don’t show you on TV or in films. You have to wait in a room preparing yourself for a momentous occasion in your life without much information on what is happening. I can remember video-calling my wife so that I could see and speak to my children before they went to bed and in my own head in case they didn’t see me again. I fell asleep. I was awoken around 4am to say that the organ was not viable, and I could go home. That was it, and no other explanation was given. The emotional rollercoaster of that 24 hours was something I had never experienced in my life, and I had to return to normal life to wait for the next opportunity.”

Unfortunately, the experience was repeated when Sanjay was called into Addenbrooke’s again in June 2020 only to be told the same thing, the donor kidney was no longer viable. On the third call, Sanjay was sceptical about the outcome.

Sanjay continued: “The third time I left for the hospital I said goodbye to my wife and kids and said I'll see them in the morning as I expected it to be another false alarm. I went through the usual motions of tests and waiting. The hours ticked by and it got later and later, and I was expecting them to come in and say it's not happening again. But I was wrong and later that evening after 10 hours under, I finally had a new kidney.”

Sanjay’s story is shared by many other kidney patients who face the turmoil of emotions when the call for a transplant comes through, and there are no guarantees of a successful outcome. Sadly, six people die every week whilst waiting for a kidney. With more research, patients like Sanjay will not have to face the all-too-common uncertainty.