Precision kidney transplant care pioneered in Manitoba
By Dr. Chris Wiebe
Winnipeg Regional Health Authority
Published Friday, March 13, 2020
Manitoba has one of the highest rates of kidney failure in Canada and across the world. That leaves a large number of people across our province on dialysis and awaiting kidney transplant.
Kidney transplant is a lifesaving option for these individuals and offers the best possible outcomes for patients living with renal failure. However, kidney transplant, like any major procedure, is not a walk in the park. It is a major operation that takes additional recovery time that is related to the compatibility of the transplanted organ.
Although more than 1,700 kidney transplants happen in Canada each year, the factors that best predict the long-term success for a given donor-recipient pair are still being actively studied by physicians and researchers.
For many years, matching donor and recipient kidneys was done in much the same way: six different proteins were compared, and the recipient would be given a score from zero to six to indicate how many mismatches they had compared to the donor.
In the last five years, with advances in the areas of genetics and protein modeling, researchers have established the ability to examine the individual building blocks that make up those proteins – like the pages that go into a book. It allows us to understand how similar, or different, those proteins are by looking at each individual block that makes up the protein. This provides an important piece of information which informs the transplant process as well as the therapy that will be needed following the procedure.
Research done in Manitoba has shown that using this new, more precise way to match kidneys provides a higher degree of accuracy when predicting whether or not the organ may be rejected. Not surprisingly, if a kidney is rejected by the immune system, this can limit its function and even lead to kidney failure.
The goal of improved organ matching is to gain better insight into the level of risk for rejection and help to appropriately tailor care plans and medication therapy. Since the medications used to facilitate organ transplant act on the immune system, hindering its function, we prefer – where possible – to prescribe less medication in order to reduce the chance of infection or other medication side-effects.
On the other hand, if we know in advance that the match will take more medical therapy to be accepted, we can plan ahead with higher doses of those medications and put together a maintenance plan to address side effects and help keep patients safe as they adjust to the transplant.
Either way, we know that kidney transplant offers the best possible health outcomes for an individual, regardless of the chance of organ rejection - this new tool has the potential to help reduce that rejection rate in tests done in Manitoba and we look forward to testing it further.
In addition to helping us select the correct medications and create individualized care plans for patients, understanding the donor-recipient mismatch in greater detail could, in the future, allow doctors select donor-recipient pairs that are better matches. This would help reduce rejection rates, reduce the need for high doses of immune suppressing medication, and lead to kidney transplants that last longer.
This Manitoba-led research, which started here 2013 and has continued to develop, is being rolled out internationally to be tested in other populations. Once validated in other regions, it could become a new way of evaluating donor and recipient matches in transplant programs around the world.
This more in-depth screening process can be easily done using existing technology and can, for the most part, be applied broadly at very little additional cost.
This work, and our continuing research, aims to create more opportunities for successful, long-lasting kidney transplants as the need for kidney transplants continues in Manitoba and across Canada.
For more information
As many as one in 10 Manitobans live with kidney disease but many may not know it since kidneys can lose up to 80 per cent of their function before symptoms are experienced. Get to know your kidneys at knowyourkidneys.ca.
To become an organ donor visit signupforlife.ca.
Dr. Chris Wiebe is a nephrologist with Transplant Manitoba and Manitoba Renal Program as well as an Associate Professor with the Rady Faculty of Health Sciences, University of Manitoba. This column was published in the Winnipeg Free Press on Friday, March 13, 2020.