2023-07-05 18:36:43
An international chain of living kidney donations and transplants was created for the first time, involving three different cities. On 20 June, the National Transplant Center (Cnt) for Italy and the Organizacion nacional de trasplantes for Spain coordinated the execution of three blood samples and three transplants in the hospitals of Padua, Barcelona and Bilbao in the space of 18 hours by crossing three pairs of donors and recipients incompatible from an immunological point of view. This is the fourth ‘cross over’ exchange of kidneys between Italy and Spain (the first was carried out in August 2018) but in all previous cases only two couples had been involved at a time, one for each country.
The chain of interventions – details a note from the NTC – started from Italy. At 8.30 on 20 June at the Padua university hospital, Professor Lucrezia Furian began the first kidney collection from a 56-year-old voluntary donor, wife of a 61-year-old patient with very difficult transplantability, hyperimmunized and in need of a new kidney for third time. At the end of the operation, the organ was immediately transported to Milan-Linate Airport with the coordination of the Veneto Regional Transplant Center, directed by Giuseppe Feltrin, and thanks to the support of the Traffic Police and the 118 service of the Paduan company. The kidney took off at 1pm on a dedicated medical flight and arrived at Barcelona airport at 2.30pm. The first exchange was carried out at the Catalan airport: the organ of the Italian donor was taken over by the health workers of the Hospital Clinic to carry out the first transplant, while a second kidney was brought on board the aircraft, taken around 12 from a Spanish donor.
The plane left for Bilbao, where the next exchange took place at 4.30 pm: the donor’s kidney in Barcelona was taken to the Hospital Universitario de Cruces for the second transplant and a third kidney, taken from the Basque hospital, was embarked with destination Milan. The air transport ended at 18.30 in Linate, from where the last organ was immediately transported to Padua by the Traffic Police: at 20.30 the third transplant began on the Italian patient, performed by Paolo Rigotti, director of the local kidney transplant center and pancreas. The intervention ended after 2 in the morning, at the end of a marathon of a total length of 2,713 kilometres. Two weeks after the operations, the recipients and donors are in excellent condition and the transplants can be considered successful.
The triple cross-donation – the note from the NTC refers again – was made thanks to the South Alliance for Transplant (Sat), an international agreement involving Italy, Spain, France and Portugal to identify common cooperation programs with the aim of giving greater chances of receiving an organ especially for patients who are difficult to transplant.
“An international chain of this type requires an enormous commitment first of clinical evaluation and then of organizational planning, to perfectly synchronize the work of all the teams and hundreds of operators and successfully complete the interventions in the shortest possible time to the advantage of a type of patient who otherwise would have very little chance of finding a compatible organ”, explains Massimo Cardillo, director of the National Transplant Center. “It is therefore an exceptional event, but it is part of the wider effort we are putting in place to promote living kidney donation, which in the vast majority of cases can take place directly between related couples. In Italy we still do too few (in 2022 there were 335, just over 16% of the total number of kidney transplants) and we still have over 6,000 people on the waiting list”.
For Cardillo it is essential to reassure patients and family members: “Living donation is a widely tested procedure, it involves very low risks for the donor while transplants of this type achieve very positive results on average. Encouraging this type of activity is one of the best ways we have in order to give an opportunity to thousands of people forced to wait a long time on dialysis”.
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