IT IS a grim dilemma: spend years more on a kidney transplant waiting list, and possibly die before you ever reach the top, or accept a diseased organ that has been patched up.
With the wait for healthy kidneys standing at two to six years in the US and Australia, and 16 years in Japan, two surgeons have been quietly transplanting diseased kidneys from living donors, who have had a kidney removed because of a small cancer or some other disorder. The organs are first repaired, for example, by removing the cancer, before being transplanted into someone with kidney failure.
Since 1991, a team led by Makoto Mannami of Uwajima Tokushukai Hospital in Ehime, Japan, has transplanted 鈥渞epaired鈥� kidneys into 42 patients whose average age was 50. Five years later, 79 per cent of them were still alive (American Journal of Transplantation, ).
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鈥淎 team in Japan transplanted repaired kidneys into 42 patients. Five years later, 79 per cent were still alive鈥�
Meanwhile, an Australian team led by David Nicol at Princess Alexandra Hospital in Brisbane, has transplanted repaired kidneys into 49 patients. The recipients were followed for an average of three and a half years, during that time four died from conditions unrelated to the transplant (British Journal of Urology International, ). The patients were all over 60, and had they stayed on dialysis in Australia, 10 would be expected to die each year, says Nicol.
鈥淭he series of patients show this is a real possibility 鈥� it can be done, and it can be done safely,鈥� says G枚ran Klintmalm, president of the American Society of Transplant Surgeons.
However, this kind of transplant is highly controversial. As 快猫短视频 went to press, the Japanese government was collecting opinions from transplant surgeons in a move that could determine whether the procedure continues. And Nicol says his work was 鈥渉ammered鈥� when he presented it to transplant surgeons in the US.
Part of the problem is that transplant recipients who receive kidneys that have had a cancer removed run the risk of the cancer returning. So far, the cause of death of one Japanese patient who received a restored kidney may have been a recurrence of cancer in the organ, and one Australian patient is being closely followed after a suspicious mark appeared on the kidney nine years after the transplant.
But also at issue is whether removing a whole kidney rather than just the tumour jeopardises the health of donors. One study suggests that for small cancers, removing the tumour alone reduces the likelihood of patients developing chronic kidney disease later on (). In Australia, the medical teams treating patients who donate and receive kidneys are kept completely separate, which removes the potential for a conflict of interest, says Nicol. But in Japan, Mannami treated both sets of patients.
Even more controversially, whereas Nicol has only used kidneys from patients with small cancers, Mannami has used kidneys with nephrotic syndrome, for example, in which the kidneys leak large amounts of protein. Here it鈥檚 even more debatable whether the best treatment for the donor is to remove a kidney.
