Saving Evan: The new transplant procedure

On the day Evan Tanner was born he was given a zero-percent chance of living, but three years later he is alive and happy, continuing to beat the odds thanks to a new transplant procedure.

Evan is nonstop, his mom, Alison Beier says “he always has a smile on his face.”

But Evan was born with a laundry list of issues, some of which Alison knew about before he was even born.

"We knew in the womb he had no left kidney. He had a right kidney but that kidney was full of cysts,” Alison said. As a result, antibodies have built up in Evan’s system.

Such antibodies, according to Dr. Gerald Lipshutz a transplant surgeon at UCLA could cause a body to reject a transplant on the operating room table if they are high enough at the time of the surgery.

Through a blood cleansing process at UCLA, Eva, who is Type-A, could receive a kidney from his mom, who is Type-AB. In a two-step process Evan undergoes I.V.I.G, a process whereby antibodies are isolated from donated blood and then high doses are infused into Evan to help prevent his body from attacking a donated kidney.

According to Dr. Lipshutz, "The other arm of the treatment is plasma pheresis, it actually physically removes proteins from the blood stream."

The whole procedure takes two and a half hours, three days a week, for several weeks, but it has allowed Evan’s mother to give her baby boy a new kidney.
"When they do an ultrasound, they laugh because they look for a little kidney and there's like this little body... and then bam! It's like a big kidney” she said.

It has been months since the transplant, and Evan is still going strong. The doctor has had a 94-percent survival rate with this type of transplant in particular.

Women who have had multiple pregnancies, people who have undergone several transfusions and those on dialysis are the most likely to need this type of treatment before receiving a transplant.

RESEARCH SUMMARY:
BACKGROUND: A kidney transplant is surgery to replace your own diseased kidneys with a healthy donor kidney. Conditions that run in the family will affect the kidneys; for instance, polycystic kidney disease is a disease where normal kidney tissue is replaced with fluid filled sacs. Glomerular disease is another condition that damages the tiny filtering units in the kidneys called glomeruli. High blood pressure and diabetes are the top two reasons why adults need kidney transplants. A person can survive on one healthy kidney; however, if something happens to that kidney, then a kidney transplant is a recommended option. (Source: kidshealth.org)

There are two types: living donors and cadaver donors. A living donor could be a family member, friend, or any person willing to give a kidney to someone who needs it. A Cadaver donor is someone who recently died. Typically the key to a successful kidney transplant is having the closest possible blood and tissue matches. Tests must be performed before hand to determine if two people are a match in order to reduce the chances of the body rejecting the kidney. Surgery normally takes about three hours where the donor kidney will be placed in the lower abdomen. Blood vessels from the donor kidney will connect to veins in the blood, and the ureter from the donor will be connected to the bladder. Blood will flow through the kidney, allowing the kidney to work properly. (Source: webmd.com)

AFTER SURGERY: Usually the patient will have to stay in the hospital for 7 to 10 days after surgery. Sometimes it takes longer than expected for the kidney to produce urine. Some may have to receive dialysis and take medicines, like diuretics, to help the kidney get rid of unwanted salt and water from the body. All patients after surgery will have to take medicines to suppress the immune system for the rest of their lives. They are supposed to help the body accept the kidney. Twenty-five to fifty-five percent of the time, the body will try and reject the new kidney for the first month. (Source: webmd.com)

NEW TECHNOLOGY: Kidney transplantation has improved survival rates and the quality of life for children and adults with life threatening kidney disease, but transplantation rates are low because of organ availability. Patients with high levels of antibodies, transplant rates are extremely low. If the patient does even receive an organ, the rejection rate is still increased. A recent approach is bringing hope to these types of patients. The revolutionary process is called hemomodulation desensitization. It is a two-step process. The first step is to undergo IVIG, Intravenous immune globulin, which are known to have powerful effects on inflammatory and autoimmune disorders. IVIG allows antibodies to become isolated from the donated blood and high doses are then infused in the patient, reducing rejection episodes. The next step is for the patient to undergo plasmapheresis (similar to dialysis), a process that filters antibodies from patients' blood and "desensitizes" them to foreign human tissue. This whole process is meant to condition the body so they can accept the new kidney. The process must be performed every day for several weeks before the surgery and several days after the surgery. (Source: hopkinsmedicine.org)

FOR MORE INFORMATION, PLEASE CONTACT:

Justin Brown, MD
UC San Diego Health System
858-246-0674
jmbrown@ucsd.edu


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