An eight-year-old girl has been spared from taking drugs for life to stop her body rejecting a kidney transplant, thanks to a UK-first treatment.
Aditi Shankar’s immune system was “reprogrammed” after a stem cell transplant so that her body accepted a donor kidney as its own.
Clinicians at Great Ormond Street Hospital in London have explained the pioneering treatment that has given Aditi an “excellent quality of life”.
Because her bone marrow transplant and kidney came from the same donor – her mother – the new organ is working without the need for anti-rejection drugs.
While providing a vital function after transplant surgery, immunosuppressants work by dampening down the body’s immune system, meaning anyone taking them is at higher risk of an infection, among other complications.
The drugs usually need to be taken for life but Aditi stopped taking them a month after her surgery thanks to the pioneering work of Great Ormond Street doctors.
Aditi's mother Divya Shankar said: “I was so happy to give her blood cells and a kidney.”
The 38-year-old shopkeeper added: “I just feel so proud.”
Her child is now able to swim, sing, dance and play on her trampoline.
Just last year she was spending a significant proportion of her time in and out of hospital for dialysis – a procedure that removes waste products and excess fluid from blood when the kidneys have stopped working properly.
When Aditi was first referred to Great Ormond Street at the age of five, doctors discovered she had a rare genetic condition called Schimke’s immuno-osseous dysplasia, which affects the immune system and kidneys.
Aditi first in UK to have kidney transplant without need for lifelong drugs - in pictures
For every three million children in the UK, doctors are likely to only find one case.
Dialysis, the first treatment on offer, meant the family had to travel from their home in Greenford, north-west London, to the city-centre hospital three times a week.
In March 2021 Aditi's kidney function dropped drastically but an organ transplant was not possible while her immune system was so weak.
So the hospital's renal, immunology and stem cell transplant teams worked with international colleagues to come up with a treatment plan.
Aditi spent four weeks in the intensive care unit having her bone marrow transplant while undergoing dialysis for 24 hours a day.
Six months later, in March 2023, she was well enough for a kidney transplant.
“My mum gave me my new blood cells,” Aditi said. “I got the kidney transplant when I went to special sleep and closed my eyes. Now I can go swimming.”
Aditi’s favourite school subject is science and she has a keen interest in biology after learning so much about the human body during her time in hospital.
Her father Uday Shankar, a 48-year-old chef, praised his daughter for maintaining a positive attitude throughout.
“Most of the support for the family has come from Aditi,” he said. “She was going in for six to eight hours a day of dialysis and then she would come home and still light the whole house up.”
Prof Stephen Marks, children’s kidney specialist at Great Ormond Street, said he has worked at the hospital for over 25 years and had never seen a case like Aditi's.
He said she is “the first patient in the United Kingdom who has had a kidney transplant to not require immunosuppressive medication after the surgery”.
Prof Marks added that due to her underlying condition Aditi would not normally be able to receive a kidney transplant.
“Her immune deficiency had to be corrected by having mum’s bone marrow first, and because Aditi was able to accept her mum’s bone marrow, that therefore meant her body could then see her mum’s kidney as being part of her,” he said.
“A month after the transplant, we were able to take her off all of her immunosuppression, which means she doesn’t get the side effects of the drugs.”
He welcomed the patient's progress and said she is now enjoying an “excellent quality of life, when in March 2021 we were in a situation of discussing what the future [was] going to hold”.
“It is exciting for Aditi to be the first patient in the United Kingdom, the first patient under the National Health Service to have had a kidney transplant for this condition and to be off immunosuppression within a month,” he said.
Asked about the potential use of the double procedure for other patients, the doctor said: “Everything in life, especially in medicine, is about the risks-and-benefit ratio.
“Undergoing this double transplant, with a bone marrow transplant then followed by a kidney transplant six months later, has a much higher risk of causing injury to the patient and also death, so we always have to balance each individual case.”
Prof Marks will present details of the case to the European Society for Paediatric Nephrology conference next week. An editorial on the findings is also due to be published in the journal Paediatric Transplantation.
