How a new treatment saved mom without kidneys
Desensitisation is pioneered in SA on mother of three
Over 10 people, including a high school friend who she had not seen in decades, had come forward to save her life but, in the end, a Johannesburg mother found her match in an incompatible family friend.
Mother of three and artist Di Wilkinson is the first South African living without both kidneys to undergo desensitisation and receive a kidney transplant.
Desensitisation is a process that removes antibodies that would have otherwise rejected a donated organ. While it’s considered a routine procedure before transplants in the United States, it is done on a small scale in South Africa.Wilkinson, 57, had been on the transplant list for five years with no success. Wilkinson’s plight reached far and wide with even an appeal from a stranger to US comedian and TV host Ellen DeGeneres to help find her a kidney.
Finally a family friend, who does not wish to be identified, came forward.
Her daughter Legh said it was heartbreaking to discover that while her mother and the living donor’s blood type was a match, Wilkinson’s antibodies were so high that she was not a compatible match with him.The family then got wind of desensitisation, which would reduce her antibodies and force a match with her live donor.
“We made contact with the South African professor who had conducted desensitisations and then transplants in South Africa to further investigate this novel treatment.
“Although he had never conducted this treatment on a patient with as high antibodies as our mom as well as a patient who had undergone a double nephrectomy – removal of both kidneys – he agreed we could give it a try,” Legh said.
Wilkinson was taken into the Wits University Donald Gordon Medical Centre theatre for the transplant on the morning of May 10.
“It was the longest wait of our lives and for the live donor’s wife. Excruciating may be the word. A few hours later the live donor was wheeled through to ICU, groggy but safe and he was followed by my mom three or so hours later. The transplant had been done,” Legh said.
She said her mother was doing well.
“She is still in pain and it is very early days. She will have a biopsy to check all is well with her new kidney.”The head of nephrology at the University of Witwatersrand and of the Charlotte Maxeke Johannesburg hospital's renal unit, Professor Graham Paget, conducted the desensitisation and transplant.
Paget explained that antibodies, which form against a potential donor’s kidney antigens, are formed through sensitising events like pregnancy and blood transfusions.
Once the procedure is conducted, a recipient’s body would no longer recognise certain antigens in the donor as being foreign, thereby accepting the organ.
“Desensitisation is not usually necessary before most transplants; it is more expensive with a higher risk of infections post-transplant. It is only necessary when a dialysis patient cannot find any donor for a transplant because his or her immune system has ‘seen’ many antigens and therefore will reject kidneys from almost anybody that you try to use as a donor,” he said.
He added that the procedure was becoming more necessary as more patients wait for years on dialysis and maybe get transfused as they experience problems.
“The key to avoiding the need to desensitise is to encourage more people to consider donating their kidney while alive or registering as organ donors in the event of death,” he said.
Wilkinson survived without both kidneys through “good dialysis and excellent compliance with diet and restriction of fluids”.
“Patients on dialysis with no urine output have a tough time. Imagine only being allowed to drink a maximum of one litre of all fluids per 24 hours every day of the year!”