February 18, 2021
Technique has potential to decrease complications and improve transplant outcomes
For the first time in Australia, researchers at The Westmead Institute for Medical Research (WIMR), along with their clinical colleagues at Westmead Hospital, have performed normothermic machine perfusion (NMP) on donated kidneys. Now, as part of a clinical trial, kidneys treated with NMP have been successfully transplanted into patients.
Donor organs are stored on ice prior to transplantation and this storage time impacts their ability to work immediately after transplantation. NMP is a procedure that ‘revives’ a kidney damaged by exposure to cold, or injury sustained during the donation process, utilising red cells, body temperature and oxygen to provide resuscitation to the kidney’s cells.
Associate Professor Natasha Rogers is Deputy Director of WIMR’s Centre for Transplant and Renal Research, and leads the Kidney Injury Research Group, as well as being a Transplant Nephrologist at Westmead Hospital. Associate Professor Rogers says that the way in which donor kidneys need to be stored during transportation can often cause significant damage to the organ.
“While the kidney must be preserved in ice, the cold temperature can damage the kidney over many hours. In some instances, the damage can be so severe that the kidney does not work after transplantation,” said Associate Professor Rogers.
The WIMR research team sought to find a way to rejuvenate a damaged kidney using NMP, and the research project was carried out by Dr Ahmer Hameed, completing a PhD, supervised by Associate Professor Rogers, Professor Henry Pleass and Professor Wayne Hawthorne.
A TGA-Approved NMP device is expensive, so Dr Hameed and the team scoured Westmead Hospital for spare machine parts. He said, “With the help of the hospital, bio-engineers and some duct tape, we were able to make a machine perfusion system suitable for our initial research.
“For this pilot stage, we sought to prove the feasibility and safety of the procedure. We were able to access donated kidneys that had been damaged to the point where they could not be transplanted, and we demonstrated in the lab that NMP could resuscitate these kidneys. Not only this, but the NMP technique seemed to improve kidney quality over time, so the kidney worked better and straight away.”
This research led to vital funding from The Ramaciotti Foundations and Royal Australasian College of Surgeons, meaning that a TGA-Approved NMP device could be purchased for the purpose of taking this research to clinical trial.
The first two transplants of a kidney treated with NMP have now been conducted at Westmead Hospital, and the results are very promising. Three months post-surgery, the patients are doing very well and have good kidney function, avoiding the need for post-operative dialysis, which occurrs in up to 50% of the kidney transplants performed at Westmead.
Professor Wayne Hawthorne, who leads WIMR’s Preclinical Studies of Islet Transplantation Group and was an integral member of the research team said, “Many transplant patients still require short-term dialysis following transplantation, but these patients have not required dialysis at all and had good urine production. This is consistent with our research, indicating that NMP can actually improve kidney quality, so they work well immediately following the transplant.
“This research also addresses the urgent issue of significant wait times for kidney transplants. There are currently more than 1,000 people in Australia waiting for a kidney transplant. Sadly, while the average wait time is around three and half years, it can be as long as seven years. Despite this, more than 8% of retrieved kidneys in Australia each year, are deemed unsuitable to transplant.
“If we are able to increase the number of donor kidneys that are suitable for transplantation, this will have a major impact on kidney transplant wait times in Australia and around the globe.”