Donor Kidney Re-Used in Second Patient After Failing in First

WEDNESDAY, April 25 (HealthDay News) — In a groundbreaking
medical report, U.S. doctors describe a case where a kidney transplanted
into one patient had to be removed but was then successfully transplanted
into another patient.

The team at Northwestern University in Chicago said that Ray Fearing,
27, received a kidney from his sister after he developed kidney failure
due to a disease called focal segmental glomerulosclerosis (FSGS). The
disease causes scar tissue to develop on the part of the kidney that
filters waste out of blood.

However, just days after receiving the new kidney Fearing showed signs
of a disease recurrence and doctors told him they had to remove the new
organ. The doctors also told Fearing they could potentially save another
person’s life by re-transplanting the organ — something that had never
succeeded before with a kidney.

“In over 50 percent of cases, transplant does not stop the process of
FSGS. When post-surgery tests indicated that Ray was at risk of developing
life-threatening conditions due to the reoccurrence of the disease, we had
to remove the kidney before he deteriorated. The kidney, however, was
still a relatively healthy, viable organ that could be transplanted into
someone else without FSGS,” Dr. Lorenzo Gallon, transplant nephrologist
and medical director of the kidney transplant program Northwestern
Memorial Hospital and an associate professor of medicine and surgery at
Northwestern University Feinberg School of Medicine, said in a university
news release.

So, with Fearing’s approval, the doctors transplanted the kidney into a
67-year-old patient. The kidney regained function almost immediately after
the second transplant and within eight days it showed a reversal of the
damage caused by the FSGS in Fearing’s body.

“This is a groundbreaking medical moment because it suggests that it is
possible to reverse the damage done to a kidney as a result of FSGS after
it is re-transplanted into a body with a healthy circulatory system,” Dr.
Joseph Leventhal, transplant surgeon at Northwestern Memorial Hospital and
associate professor of surgery and director of kidney and pancreas
transplantation at Northwestern University Feinberg School of Medicine,
said in the news release.

“Not only did we save a viable organ from being discarded, we also made
significant strides in better understanding the cause of FSGS, which has
been relatively unknown, so we can better treat the disease in the future.
This also proves that when an organ fails in one body, it may thrive in
another,” he added.

The report appears in the April 26 issue of the New England Journal
of Medicine
.

One expert said the successful re-use of the donor kidney could be a
milestone.

“This case represents a unique and innovative addition to current
scientific, humanitarian and ethical practices, and establishes a
precedent to improve patient survival and quality of life,” said Dr.
Ernesto Molmenti, vice chairman of surgery and director of the transplant
program at the North Shore-LIJ Health System in Manhasset, N.Y.

But, he also said the procedure raises interesting new questions, such
as “Should the initial donor and recipient have any input on the second
allocation of the kidney? Should the kidney be offered first to the
original donor prior and then to a second recipient? [and] What type of
priority [if any] should the first recipient be granted when being
considered for a second transplant?”

For his part, Fearing is back on dialysis and still hopes to receive
another kidney transplant in the future.

“It may not have been my time, but I am grateful that I was able to
help another patient,” he said in the news release. “My day will
come.”

More information

The National Kidney Foundation has more about kidney transplantation.

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