Game-changing kidney transplant technique developed in Toronto hospital

By Jessica Bruno & Amanda Ferguson

Surgeons at Toronto General Hospital are celebrating a medical breakthrough that could dramatically improve the lives of people waiting for a new kidney.

“We are changing the landscape of kidney transplantation,” said Dr. Markus Selzner, a transplant surgeon at the University Health Network.

For the first time in North America, a donated kidney has been successfully transplanted into a patient using a new system Selzner helped pioneer. It’s the result of four years of work by the surgeon and a team of scientists from the University Health Network, Canadian Blood Services and SickKids Hospital.

The team has developed a machine and kidney support system that keeps the organ healthy by mimicking conditions inside the human body.

The procedure works by storing a kidney in a special “soup” of nutrients at body temperature, which helps restore the kidney before it is transplanted. Doctors can also monitor the organ prior to transplant.

The current system actually cools a kidney down to slow down metabolism before surgery, but Selzner said that can damage the organ.

“This is a major change,” said Selzner. “Instead of being exhausted at the time of transplant, now [the kidney] is in great shape, it’s fresh, it’s full of energy, it’s like a champion. It goes in with a bang and now it will work immediately.”

About 1,000 Ontarians are on the waiting list for a kidney, and the average wait is four years.

Transplant specialists have been trying to address the wait list time by using organs from older donors and other non-ideal candidates. But the kidneys those donors give are more delicate. Under the current system, it’s hard to tell how well an organ will work once it is transplanted.

With less of a struggle, Selzner said patients should recover more quickly and have better long-term health.

In November 2017, 53-year-old Zhao Xiao was the first person to receive a donated kidney that had been taken care of using the new technique.

Through a translator, Zhao said he’s been feeling great since the surgery.

“I feel very lucky,” says Zhao.

Zhao needed a new kidney due to complications from diabetes and hypertension. He waited just over a year for the transplant, which he noted is shorter than usual.

During his wait for a transplant, Zhao had to use a dialysis machine for eight hours a day. He said it affected his sleep and left him tired all the time.

Zhao’s new kidney was hooked up to the machine for 3.5 hours before surgeons transplanted it.

“It went really fantastic,” said Selzner. “I have rarely seen a kidney working so well after transplantation.”

Selzner said blood tests taken less than two days after the transplant showed Zhao’s new kidney was working well, and Zhao says he has a lot more energy now.

The transplant was the first step in a clinical trial at Toronto General Hospital and the University Health Network. Selzner said the next step is to do more transplants to show the procedure is reliable.

If widely adopted, Ontarians could soon be waiting less time for a kidney transplant. But Selzner says the improvements don’t have to end there. In the next 10 years he predicts his procedure could evolve to prepare organs specifically to suit a particular patient’s body, hopefully lessening the chance their body rejects the new organ.

In Ontario, about 20 per cent of all transplanted kidneys are donated by non-ideal candidates. In that group, the average donor age is more than 60 years old.

Under the new system, more kidneys may be eligible for transplant.

And while the transplant surgeon is excited about his team’s progress, Selzner said the real thanks should go to the organ donors.

“The real thankfulness is for the donor, who is giving the gift of life,” he said. “We must take care of it as well as we can. I hope that with this technology we can make the gift of a kidney better.”

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