Breakthroughs

BARNES-JEWISH PARTICIPATES IN 16-PATIENT, FOUR-CENTER DOMINO KIDNEY TRANSPLANT

SEPTEMBER 08, 2009

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What is believed to be the largest multi-center domino kidney transplant in the United States was completed July 6 when surgeons at Barnes-Jewish Hospital removed a kidney from Christine Hargis, 36, of Coello, Ill., and transported it to The Johns Hopkins Hospital in Baltimore, where it was transplanted into a waiting recipient.

This transplant closed a series of “paired kidney exchanges (PKEs),” that began June 15 and involved 16 patients at four different transplant centers, including Integris Baptist in Oklahoma City and Henry Ford Medical Center in Detroit, as well as BJH and Hopkins.

PKE matches a potential kidney recipient who has a willing donor whose blood or tissue doesn’t match the recipient with a similar “mismatched” donor/recipient pair. The pairs exchange kidney donors so each recipient receives a compatible kidney. Comparing lists of mismatched donor/recipient lists at several transplant centers allows for more potential matches.

In this exchange, eight donors — five women and three men — donated kidneys to eight recipients — five women and three men — at the four hospitals over three different days. Doctors said all the patients were in good or satisfactory condition after the surgeries.

The first BJH surgery in the chain was June 22, when Mu Cha Leffler, 60, received a kidney from a donor at Hopkins. The donor kidney began working as soon as it was implanted into Leffler, according to Washington University transplant surgeon Surendra Shenoy, MD.

Leffler was discharged from BJH June 26. Leffler, of Christopher, Ill., is Hargis’s mother.

Leffler, whose kidney failure was a complication of her battle with diabetes, had been on dialysis three times a week for two years. The dialysis treatments, though lifesaving, kept Leffler from fully enjoying her life, said her husband of 39 years, Dale.

She’d be wiped out right after the treatment,” he said. “The next day she’d feel pretty good, but the morning after that, she’d feel bad again and it was time for treatment.

She’s looking forward to spending time with her grandchildren and working in her garden again, Dale Leffler said.

Hargis had intended to donate her kidney directly to her mother. But testing showed that they weren’t a blood antigen match. Antigens in Leffler’s blood also made it unlikely that she would ever find a matching cadaver donor, said Dr. Shenoy.

The domino procedure involving the three medical centers speaks to the lack of organ donors throughout the nation.

There are many institutions that do living donor transplants, but there are so many people on the waiting list,” says Dr. Shenoy. “Through this domino exchange, we want to set a national model.”

This is the second multi-center exchange BJH has participated in. On Feb. 14, Dr. Shenoy and Washington University transplant surgeon Martin Jendrisak, MD, participated in a six-way swap, in which 12 patients at BJH, Hopkins and Integris Baptist swapped kidneys.