Greetings, Dr. Roach I read your most recent column about dialysis and transplants.
I was told I had polycystic kidney disease fifteen years ago, and a transplant was suggested. My wife and I learned that our blood types—mine being A positive and hers being B positive—were incompatible. She wanted to help with a transplant chain switch for me because I had begun dialysis. It seemed like a way for her to assist. However, she was not qualified for the chain swap because she had a scar on her left kidney from the removal of her adrenal gland owing to Cushing disease in her twenties.
We were given the option of an ABO incompatible transplant, nevertheless. Because our titers were 16:1, the transplant preparation time was decreased. Heidi, my wife, was pleased to be able to assist me in this way. In October 2009, we received the transplant, and in 2015, my 37-pound native kidneys were removed.
Dr. L, the surgeon, reported that as he was attaching it to me, my wife’s kidney began to function. My overall time on dialysis was less than six months. I recently had my yearly checkup with Dr. L. after losing my Heidi in June 2022. She continues to take wonderful care of me, and my stats are good. Even though we couldn’t get along, we were a couple! — D.B.
ANSWER: This is a heartwarming tale, and I hope it clarifies a few things for readers. About half of those with autosomal dominant polycystic kidney disease (ADPKD), a prevalent hereditary disorder, develop end-stage kidney disease. The recommended course of treatment for ADPKD is transplantation.
Two or more potential donors who are incompatible with their friend or family member give their kidneys to someone they are compatible with in paired transplants, often known as transplant chains. In this manner, living kidney donations—the finest form of transplants for the recipient—can be given to numerous people. The National Kidney Foundation’s website, tinyurl.com/KidneyDonorChain, has additional information about these.
An incompatible transplant was an additional option because your wife’s operation prevented her from donating a kidney. Previously, we didn’t believe that a blood-type-incompatible transplant could be an option when paired donation or chain swapping aren’t feasible.
As you mentioned, the recipient must undergo plasmapheresis, which involves removing as many antibodies as possible; receiving treatment (rituximab) to lower the quantity of antibodies the recipient will produce; taking immunosuppressive medications; and receiving intravenous immunoglobulin to replace the antibodies that plasmapheresis removed. Naturally, this calls for a high level of skill, and only a few transplant institutions nationwide carry out these procedures.
After a transplant, native kidneys are usually not removed, but yours were huge. (The average kidney weighs roughly 250 grams, or half a pound.) Following a transplant, the cysts may continue to grow in patients with ADPKD. Sometimes these big kidneys need to be removed because they can hurt, put pressure on the stomach, induce reflux or weight loss, get infected, or bleed.
Although I’m sorry you lost your wife, it’s a wonderful and priceless gift that her kidney is still functioning inside of you!
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