The transplant team at St George’s Hospital has performed its first tissue incompatible (also known as HLA incompatible) kidney transplant on a patient from London.

Debra Gouldbourne, from Catford, was born with a condition that caused her kidneys to fail and received her first kidney transplant in 1986. In 2010 this kidney also began to fail and Debra’s daughter Jade came forward as a potential donor.

Jade was tested as a match for Debra but, disappointingly, the results showed that her body would attempt to reject the organ. Despite this setback, innovative medicine and the support of a multi-disciplinary healthcare team meant the transplant could still go ahead.

Normally when a donor receives a tissue incompatible organ, the body’s immune system will attack the kidney with antibodies and cause it to fail. In Debra’s case a complex series of treatments successfully bypassed her body’s natural response, allowing her to accept the organ.

A month before her operation Debra was given an infusion which removed some of the white cells – cells responsible for producing antibodies and triggering an immune response – from her blood. She also went through a treatment known as double filtration plasma exchange, which reduced the unwanted antibodies already present in her bloodstream to very low levels.

The very low levels of antibodies in Debra’s bloodstream allowed the kidney to be accepted and, over four months after the transplant, Debra has fully recovered and there has been no sign of rejection. Though Debra will continue taking immunosuppressive medicines for the rest of her life, she is back to everyday life with normal kidney function.

Debra said: “Accepting a kidney from my daughter has been a very emotional experience for both of us. We spoke to each other over a long period of time and built up to the surgery together, so we shared a huge emotional journey as well as the physical recovery.”

Jade said: “I had always known that my mum was sick and may at some point need a transplant, so my brother and I had decided a long time ago that when the time came for another transplant the organ would come from one of us. Despite the disappointment of the compatibility tests I was determined that if there was a way to make it work we would try.

“The idea of donating a kidney was scary but the clinical team at St George’s were really reassuring and gave me great confidence. They really did everything they could to make both of us comfortable and keep us informed so that we understood what was happening. I can’t thank them enough for what they’ve done for us.”

Both Debra and Jade are Jehovah’s Witnesses so cannot accept blood transfusions, which made the surgery more complicated, but overall a greater achievement.

Consultant renal transplant surgeon Mohamed Morsy (recipient surgeon) said: ”Debra’s faith dictates that she cannot receive any blood transfusions. Therefore a key challenge to the theatre team was making sure that we absolutely minimised blood loss during the operation. Though we put into place special measures in line with her faith to control blood loss, she bled very little which was the perfect result for us.

“The transplant went well in all aspects: removal of Jade’s kidney was very straightforward and likewise Debra’s operation went ahead successfully without complication.”

Consultant renal transplant surgeon and lead in antibody incompatible transplantation Nicos Kessaris (donor surgeon) said: “The surgery was a big success, but this is not a story about surgery alone. The preparation for surgery is what made this whole procedure possible and that is down to the talented multidisciplinary team of doctors, nurses, clinical scientists and surgeons we have at St George’s Hospital.

“Debra was perfectly prepared for the procedure when she reached the operating table. Suppressing her immune system so that she could successfully accept Jade’s kidney was very challenging and is a huge achievement for the team. It has led to a very positive outcome for Debra and her family and we are very pleased for them.”

It is believed that this first incompatible kidney transplant at St George’s Hospital is the only time in the world that the procedure has been conducted between two Jehovah’s Witnesses.

Notes to editors

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