Researchers have made a discovery that could have a huge impact on patients waiting for a transplant after they successfully altered the blood type of three donor kidneys.
The development is good news for patients from minority groups who are less likely to find a match because it could increase the supply of kidneys available for transplant, scientists say.
Normally, a kidney from someone with A-type blood cannot be transplanted to someone with B type, or vice versa.
But changing the blood type to the universal O will allow for more transplants because this can be used for people with any blood type.
University of Cambridge researchers used a normothermic perfusion machine — a device that connects with a human kidney to pass oxygenated blood through to better preserve it — to flush the organ with blood infused with an enzyme.
The enzyme removed the blood type markers that line the vessels of the kidney, which led to the organ being converted to O type.
“Our confidence was really boosted after we applied the enzyme to a piece of human kidney tissue and saw very quickly that the antigens were removed," said Serena MacMillan, a PhD student at the University of Cambridge.
“After this, we knew that the process is feasible and we just had to scale up the project to apply the enzyme to full-sized human kidneys.
“By taking B-type human kidneys and pumping the enzyme through the organ using our normothermic perfusion machine, we saw in a matter of just a few hours that we had converted a B-type kidney into an O type.
“It’s very exciting to think about how this could impact so many lives.”
Iran’s cash-for-kidney programme mired in controversy - in pictures
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Surgery tools during a kidney transplant operation at Modarres Hospital in Tehran, Iran. Ebrahim Noroozi/AP Photo -
Handwritten advertisements for kidneys for sale, that include the sellers’ phone number and blood type, posted on a door in downtown Tehran, Iran. Ebrahim Noroozi/AP Photo -
Iran has a unique system allows those in need of a transplant to buy a kidney. Ebrahim Noroozi/AP Photo -
The programme has seen Iran’s waitlist for kidneys effectively drop to zero, but some ethicists worry about the system taking advantage of the poor worldwide to black-market organ sales. Ebrahim Noroozi/AP Photo -
Sajjad Ghanbari undergoes a medical exam as part of the process of selling his kidney, in a clinic in downtown Tehran. Ebrahim Noroozi/AP Photo -
Hassan Hamdampay uses a dialysis machine at a clinic in downtown Tehran on August 6, 2016. Ebrahim Noroozi/AP Photo
People from minority groups often wait a year longer for a transplant than white patients, and so the study could have particular implications for them, experts say.
People from minority communities are more likely to have B-type blood, and with current low donation rates from these populations, there are not enough kidneys to go around.
In 2020-2021, just over 9 per cent of total organ donations came from black and other minority groups, while these people make up 33 per cent of the kidney-transplant waiting list.
Now the researchers need to see how the newly changed O-type kidney will react to a patient’s usual blood type in their normal blood supply.
The machine allows them to do this before testing in people, as they can take the kidneys that have been changed to the O type, and introduce different blood types to monitor how the kidney might react.
Bangladesh’s illegal kidney trade booms - in pictures
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Rawshan Ara, 28 (R) and her husband at their home in the village of Kalai some 300 kms north-west of Dhaka. Suvra Kanti Das / AFP -
Rawshan Ara, shows her medical records — which are in another name — in the village of Kalai. Suvra Kanti Das / AFP -
Shukkur Ali, 21, a victim of illegal organ trade, poses in the village of Kalai. Shukkur Ali received $5,350 for selling his kidney in neighbouring Sri Lanka. But the 21-year-old has been hospitalised three times in the last six months with complications. Suvra Kanti Das / AFP -
Bangladeshi villager Mokaram Hossian, 35, a victim of illegal organ trade, shows the scars from his illegal kidney removal operation. Suvra Kanti Das / AFP -
A Bangladeshi villager walks between homes in the village of Kalai. Suvra Kanti Das / AFP -
Rawshan Ara, 28, poses at her home. Suvra Kanti Das / AFP -
Josna Hossian, wife of Belal Hossian poses at her home. Suvra Kanti Das / AFP
“One of the biggest restrictions to who a donated kidney can be transplanted to is the fact that you have to be blood group-compatible," said Mike Nicholson, professor of transplant surgery at the University of Cambridge.
“The reason for this is that you have antigens and markers on your cells that can be either A or B. Your body naturally produces antibodies against the ones you don’t have.
“Blood group classification is also determined via ethnicity and ethnic minority groups are more likely to have the rarer B type. ”
Dr Aisling McMahon, executive director of research at Kidney Research UK, said: "The research that Mike and Serena are undertaking is potentially game-changing."
After testing the reintroduction of other blood types, the team will look at how the approach might be used in a clinical setting.
The research, which is funded by the charity Kidney Research UK, is due to be published in the British Journal of Surgery in the coming months.
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Ayesha, from Bury in Greater Manchester, had Stage 3 chronic kidney disease diagnosed in 1998 when she was pregnant with her first child.
Ayesha's kidneys deteriorated rapidly during the pandemic and she was told that she would need a transplant, but she might have to wait double or even triple the amount of time for a kidney as a white person.
Consultants estimated that she might have to wait between six to 10 years to receive one.
“They explained that because of my ethnicity, my wait for a deceased donor will be longer than for a white person," Ayesha said.
“The reason being my background – being the Muslim community and other faiths and cultures often don’t agree to be organ donors.
“I feel sad at the thought of waiting so long for a transplant. I understand a transplant isn’t a cure, but it would make my body a lot stronger and give me a second chance at a healthy life.”
“Even after the law change so everyone was automatically made an organ donor, many people decided to opt out.
“The research will offer so much hope to minority groups still waiting for a transplant and could help to save many lives.
“Convincing communities that research such as this and organ donation is beneficial is so crucial to improving and saving lives.”
