Published: Tuesday November 19, 2013 MYT 12:00:00 AM Updated: Tuesday November 19, 2013 MYT 7:10:17 AM
WHEN his elder sister’s kidneys both failed in 2009, operations manager Yow Kok Kheong wanted to give her one of his.
Then antibody tests showed they were not a match.
But early this year, against all odds, 38-year-old teacher Yow Sok Fun successfully received a kidney from her brother, 35.
This was after Singapore General Hospital (SGH) had devised a way to condition the patient’s body to accept an incompatible transplant.
The public hospital now joins two others in offering kidney transplants from patients who have incompatible antibodies, though their methods may differ slightly.
National University Hospital has performed 14 such procedures since 2009, while Mount Elizabeth Hospital has had at least seven in the past five years.
For SGH, Yow was their first.
The latest development offers yet another avenue for patients who have trouble finding a suitable donor, said surgeon Terence Kee, who heads SGH’s renal transplantation programme.
“We can re-open the transplant option to patients who are on the waiting list for a kidney,” he said.
Kidneys from deceased donors are getting harder to come by.
Figures from the National Organ Transplant Unit showed that the number of deceased donors hit a five-year low last year at only 23. This is down from 36 in the preceding year.
But the waiting list for kidneys is many times longer, with more than 400 requiring one each year.
The average wait is about nine years.
“Chances are bleak for these patients,” said Dr Kee, who operated on the siblings in January. “Still, we always try to find a compatible donor first. The new protocol is the last resort.”
About two years ago, the Yow siblings had failed the “T-cell cross match” test that determines if there are antibodies that will cause rejection.
Yow, who is married with two school-going children, had very high levels of problematic antibodies due to previous pregnancies and blood transfusions.
In such situations, doctors normally will not proceed with the transplant due to the high risk of rejection – more than 80%.
But the hospital, for the first time, tried an approach in which she received regular infusions of a blood product in the months leading up to the surgery, to reduce the amount of “bad antibodies”.
The blood product, called intravenous immunoglobulin, is extracted from donated blood. One of its functions is to help “switch off” the production of the bad antibodies. After this, Yow’s blood was filtered through a machine to remove the antibodies.
Dr Kee said not everyone is suitable for the latest approach. For instance, they have to be healthy enough for the blood filtering procedure, which may cause low blood pressure. This can in turn trigger a heart attack or stroke in vulnerable patients.
Since the surgery, Yow has recovered without complications. Initially, she had hesitated due to the higher risks involved.
“With surgery, there is always the chance that you will die during surgery,” she said.
“But there was also a very high risk that the transplant will fail – which meant my brother’s kidney would be wasted.”
But they decided to go ahead, said her brother, partly because dialysis had not been easy on his sister.
The thrice-weekly sessions tired her out, plus there were strict dietary limits – only four cups of water were allowed a day.
The constant use of needles meant her veins got blocked, so regular ballooning procedures were needed to re-open the vessels. “It was worth taking the risk, a no-brainer,” he said. — The Straits Times / Asia News Network