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St. Michael’s first in North America to use blood-cleaning procedure for kidney transplant

Procedure allows man to receive kidney from brother with different blood type

Toronto, September 9, 2011

Dr. Stephen Hwang Dr. Jeff Zaltzman of St. Michael's speaks to Andre Cossette after the plasmapheresis procedure. (Photo: Leslie Shepherd)

By Leslie Shepherd

St. Michael’s Hospital is the first in North America to have used a novel device that cleaned the blood of a kidney patient and allowed him to receive a transplant from a donor with a different blood type.

Transplants involving a donor and recipient with different blood types are rare. Most people have natural antibodies in their blood that would cause their immune system to reject an organ from someone with a different blood type.

Andre Cossette, a Grade 4 teacher at Ange-Gabriel Elementary Catholic School in Mississauga, Ont., was on dialysis for three years before undergoing a procedure called plasmapheresis at St. Michael’s. He then received a kidney transplant from his brother, who has Type AB blood, even though Cossette has Type A blood and antibodies against Type B.

Plasmapheresis is similar to kidney dialysis, which removes waste products from the blood. Plasmapheresis separates plasma from patient’s blood, and runs it through a column-shaped device containing synthetic carbohydrate beads that trap the blood group antibodies. The “washed” plasma is then returned to the patient’s body.

St. Michael’s was the first hospital in North America to perform plasmapheresis using a device known as the Glycosorb ABO, developed by Glycorex Transplantation, a Swedish company, and approved by Health Canada last year. It has been used once in Canada for a recent heart transplant in Alberta, but this was the first time for a kidney patient. The device is used in 21 countries, mainly in Europe, for kidney, liver, heart, lung and stem cell transplants.

“I get to get my brother’s kidney,” Cossette said, shortly after beginning the first procedure, which lasted about four hours. “I won’t have to be on a waiting list, waiting for a call to come to the hospital within four hours because there may be a kidney available.”

Cossette underwent the procedure a second time to get rid of all the antibodies. He will also receive medications to prevent his immune system from making more antibodies and attacking the transplanted kidney.

Dr. Jeff Zaltzman, director of the hospital’s kidney transplant program, said the procedure could expand the number of living organ donors. More than one-third of potential live donors are turned down because their blood types are not compatible with the person to whom they wish to donate their kidney.

“Every time you have a living donor, you’re helping someone who would otherwise be on a transplant waiting list for a long time,” Dr. Zaltzman said. “That’s also one more person who is not taking an organ from a deceased donor, which could then be given to someone else.”

Dr. Zaltzman headed the transplant team that also included Dr. Katerina Pavenski, a hematologist, and Dr. Ramesh Prasad, a nephrologist at St. Michael’s Hospital.

In Ontario, 1,075 people are on a waiting list for a kidney transplant, according to the Trillium Gift of Life Network, the province’s organ and tissue donation agency.