Kidney transplant patients to get blood matched for white blood cells in new pilot
When needed, kidney transplant patients at Hammersmith Hospital will have access to blood transfusions matched not just for red blood cells but also for the donor’s tissue type, as part of a new pilot programme to help reduce the formation of immune system antibodies and transplant rejection.
The programme is going live this month. NHS Blood and Transplant will match the blood at a specialist Histocompatibility and Immunogenetics laboratory in Colindale, London, and supply it for pre and post-transplant patients who need this treatment at Hammersmith Hospital.
If the pilot programme proves successful and a national matching programme is then rolled out, it could significantly reduce the time spent on the waiting list for a transplant and help prevent premature transplant failure. NHSBT data analysis shows current transplant graft survival and patient survival are significantly higher for patients who do not receive transfusions.
Human leucocyte tissue antigen (HLA) typing, also called tissue typing, is not normally needed for most blood transfusions. The creation of HLA antibodies against unmatched transfused white blood cells usually has no consequence. However, in transplant patients, these HLA antibodies may harm the transplanted kidney because they consider it to be ‘foreign’.
Research to better understand the impact of mismatched HLA antigens was undertaken at Imperial College Healthcare NHS Trust by a team led by transplant nephrology lead, Dr Michelle Willicombe, and supported by the National Institute for Health and Care Research Imperial Biomedical Research Centre.
Around two out of every five kidney transplant patients need blood transfusions before or after transplant. Transfusions save lives but they are also associated with double the risk of losing the transplant, according to NHSBT statistical analysis, due to the formation of HLA antibodies.
Additionally, in people waiting for a potential transplant, one in four have a delay to finding a match due to transfusion antibody formation with some patients never being offered a suitable match.
A successful programme and wider roll out would not just provide better patient outcomes also save the NHS money – if a patient needs to return to hospital dialysis that costs the NHS around £20,000 to £33,000 a year.
The potential wider roll out is now possible thanks to advances in the ability to DNA test blood large scale. NHSBT has recently started to use the new Axiom array genotyping test, developed by the Blood transfusion Genomics Consortium (BGC), which offers the ability to potentially HLA type many more donors, as it is cheaper than current testing methods.
Should the programme prove to be a success, NHSBT estimates it will need at least 130,000 blood donors to be HLA typed to make the supply of fully HLA-matched red cells routine for kidney transplant patients. Currently, just under 100,000 donors are typed.
During 2022-23, 2,339 people received deceased donor kidney transplants in the UK. There are currently – as of the end of March – 5,870 people on the kidney transplant waiting list.
Dr Willicombe said: “There is no known effective treatment for HLA antibodies, which can be a barrier to successful transplantation. This important innovation will help prevent their development before and after transplantation, where a blood transfusion cannot be avoided. We hope it will make a meaningful difference to our patients.”
Dr Colin Brown, NHSBT consultant clinical scientist, head of histocompatibility and immunogenetics at Colindale, said: “In this pilot programme, we are going to HLA-match red blood cell transfusions for renal transplant patients to avoid sensitisation against the donor kidney and so reduce the risk of kidney transplant rejection.
“If renal patients produce HLA antibodies in response to transfusions, this could potentially affect access to transplantation and transplant outcomes. This is an innovative pilot programme, and we hope to improve patient outcomes.
“Each year, around 1,000 kidney patients who are transplanted will also receive a transfusion. If all of them could benefit from a successful transfusion programme and a wider roll out, our models show 100 kidney transplants a year could be saved.”
Fiona Loud, policy director at Kidney Care UK, said: “Receiving a transplant and then maintaining one for as long as possible is so important for people with kidney failure. Waiting for a transplant is incredibly hard and those with greater antibody sensitisation can wait even longer. Organ rejection is a huge concern for people who have had a transplant, and this pilot will give them the hope of longevity. With the waiting list at a ten year high and 80% of the people on the list waiting for a kidney we need action to improve the outlook for people with kidney disease when it comes to transplantation in the UK.”
Alisha Gorkani, aged 25, from Sidcup in the London Borough of Bexley, a solutions advisor for a tech company, has for juvenile nephronophthisis and has spent seven years waiting for a matching kidney transplant.
She has developed antibodies from a mix of blood transfusions and a past kidney transplant.
Alisha said: “I have a lot of antibodies so I could be waiting a very long time. I try to make the best of things but waiting for a kidney and being on dialysis is incredibly hard.
“It does give me hope that people like me could have better matched blood in the future. There are thousands of people hoping for a miracle match.”
