Cape Town - UCT Private Academic hospital has joined the ranks of hospitals across the world with the successful completion of its very first ABO-incompatible (ABOi) kidney transplant this year.
Usually, kidney transplants are only done with compatible donors and recipients, but in this procedure Chantal Davids, 39, who has blood type O+, received a kidney from Dr Faiza Toefy, 53, who is B+. Toefy is not Davids’s doctor, but she was good friends with Davids’s mother, Avril Cloete, who died in 2009.
Toefy said that when Cloete needed a kidney transplant, she had also wanted to donate, but they were not a match. Despite Toefy and Davids also not being a match, this surgery ensured that this time she could help.
Toefy heard about Davids’s condition from a family member. At this point, Davids had been on the waiting list for a kidney for three years and none of her family members could donate, as it was suspected that the disease was genetic. She only discovered she had kidney disease after her mother was also diagnosed with it.
Professor Elmi Muller with Chantal Davids. Picture: Supplied
When Davids and the rest of her family had tests, it was found that her kidney function was not normal.
“I was heading to renal failure.”
She had to see a nephrologist at Groote Schuur every six months and also went on blood pressure medication to control kidney function. When she fell pregnant with her son, Adam, who is now six years old, she had to be closely monitored.
In 2012, after feeling ill and having tests, her nephrologist told her she was in renal failure. “I was devastated because I had this baby who needed a mommy.”
After a few days in hospital on a drip, her kidney function improved and she was discharged. In 2014, she went into in renal failure again. “This was it. I knew there was going to be a stage that I would need dialysis.”
She went on peritoneal dialysis, which can be done at home. However, eventually it stopped working for Davids. Then she started hemodialysis, which filters toxins out of the blood using an external filter. It's usually done in hospital. She had this for about six months before the transplant. The driving force for this it was Professor Elmi Muller, transplant surgeon at UCT Private Academic hospital.
“I wanted to get a solution to help Chantal and she had this wonderful donor who wanted to give her a kidney. I really felt they should be helped and there were no other options for them. We now have a lot more patients who came forward and want to get this treatment option.”
A lot of planning had to go into preparation for surgery. “Because Chantal was ABO incompatible with her donor, we had to do a few sessions of plasmapheresis and give her extra anti-rejection medication before the procedure.
"The procedure is carefully monitored and we do antibody titres regularly before the transplant. As soon as these levels are down, we can proceed by doing the transplant. This is followed up again with more tests - daily antibody and ABO titres. The actual transplant procedure is the same as other transplants.
"We are quite careful with the vessels as they can clot easier than with other patients, but the surgical procedure is a routine kidney transplant.
Chantal Davids and Faiza Toefy, with matching kidney bean charm bracelets. Picture: Supplied
"I work closely with a nephrologist Dr Zunaid Barday, who helps me look after the patients and monitor all these titres and drugs.”
The operation was a first for the hospital. “There are centres doing ABO-incompatible transplants all over the world, but we have never done it before at UCT. The reason was that we did not have the technology and expertise before - we started reading and working on this about a year ago. Because there is such a big need for this, we felt this is something we should offer our patients.”
Davids had an episode of severe rejection immediately after the transplant, but this was soon rectified with escalated plasmapheresis and drug treatment.
Both Davids and Toefy are doing well since the procedure and have also developed a close relationship. Toefy, who got married a few months after the surgery, joked that she planned her wedding around it, as she wanted Davids there because “I wanted both my kidneys at my wedding."