Thursday, 18 July 2013

First kidney cross-transplants take place in Andalucía

ANDALUCÍA Two regional hospitals, Puerta del Mar in Cádiz and the Regional in Málaga, recently performed the first successful kidney transplant using living donors at two separate entities several hundred kilometers apart. The cross-transplant took place between two couples, one from Cádiz, the other from Málaga, the women of which had a serious kidney failure. The woman from Cádiz, 57, had been on haemodialysis since 1994. Her husband, 60, was the donor for the female patient in Málaga. The woman in Málaga, 55,>>>

had been on haemodialysis for the last five years due to a chronic kidney condition. Her husband was the donor for the Cádiz patient. All patients are doing very well, according to sources at the regional transplant unit.

Compatibility was a problem
According to Dr. César Remón, a member of the inter-hospital transplant team, it was a very complicated case, with considerable immunological risks, as one of the receptors present antibodies that did not match her donor's. However, the patient was 'de-sensitised' successfully, and compatibility was instituted so that the organ would not be rejected.

Coordination was a large part of the operation. Team work was essential, according to Dr. Álvarez-Ossorio, another member of the team. Coordination was necessary not only in terms of transportation (by helicopter) from both hospitals to the other, but also for the medical transplant teams at either end. The senior nurse involved, Lourdes Benítez, of the Transplant Coordination unit at Puerta del Mar, said that both operations had to be carried out at the same time to guarantee equal success in both cases.

Kidney transplants are the most successful
The physicians involved, including Drs. Luis Miguel Torres and Julio Pastorín, unmentioned above, pointed out that kidney transplants from living donors are the most successful transplants so far. They are the best bet for patients with chronic renal conditions, and the donor is usually a close family member in the most successful cases, though there are cases where incompatibility is present, thus impeding direct donation, such as the transplant described above.

The best solution, not frequently possible, is a cross-transplant such as this.

Puerta del Mar as a reference point for transplants
Living donor cross-transplant operations have happened before at Puerta del Mar, though these were local patients in Cádiz. Other cases have taken place with other hospitals in Spain, too, but this is the first time such operations were between hospitals within the health service of Andalucía, but in different provinces.

Indeed the Cádiz institution - a teaching hospital, too - has become a transplant reference point at national and international levels, according to Dr. Álvarez-Ossorio, who heads the Urology Clinical Management Unit.

The Renal Cross-Transplant National Programme was established in 2009, since when 16 such operations have taken place nationwide. Six of them at Puerta del Mar.

Laparoscopy as an essential tool
The introduction of laparoscopy has been crucial in live donor transplants because it is much less invasive and recovery is that much faster. Most cases are released from the hospital the following day.

The number of live donors has increased over the last few years, while those from cadavers have decreased. The waiting list, though, remains approximately stable at 100, largely due to the fact that new patients have been put on the list because they are now considered 'transplantable', whereas they would not have been just a few years ago. New techniques are introduced almost every year.

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