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Robert Montgomery — Incompatible Kidney Transplant Registry

What's next for the Johns Hopkins surgeon who orchestrated the world's first 16-patient, multi-hospital kidney transplant swap?

How about a national registry for domino kidney transplants that could lead to a quantum leap in the number of surgeries performed – from 200 a year in the United States to 3,500?

For Dr. Robert A. Montgomery, Director of the Comprehensive Transplant Center at The Johns Hopkins University and Hospital, successfully creating such a registry with a $500,000 ARRA Challenge Grant would mark a major advance in this fast-emerging field where he already is the world's recognized expert on kidney swaps in which patient and donor blood types are incompatible.

Each year, 4,000 patients with kidney failure find healthy, willing donors but then learn that blood-type or sensitivity issues make a transplant impossible. Their only remaining option: Joining 84,000 patients on a waiting list for deceased donor kidneys. Many never survive long enough to get to the top of the list.

For these patients, domino kidney transplants offer a promising avenue of hope. By taking a group of incompatible donor-recipient kidneys and matching them with other pairs in a similar predicament, it is possible to give each recipient a new kidney that won't be rejected.

Hopkins' five-year survival rate for kidney paired donations is nearly 89 percent – which is similar to success rates for normal kidney transplants.

"This field is only about ten years old," says Dr. Montgomery, who performed the first paired kidney donor swap at Hopkins in 1998 and established the protocol for this complex set of surgeries. "The field is so new that it is unclear how widespread the practices are and who is doing what."

Not only does a national registry vastly enlarge the potential for kidney matches, it allows Dr. Montgomery to create a national database for incompatible kidney surgeries, procedures used and outcomes. From that, Dr. Montgomery will generate new protocols and best practices that surgical teams can use to expand paired kidney swaps.

Johns Hopkins, the Mayo Clinic and Cedars Sinai Medical Center are the high-volume sites for this specialized surgery. The rest of these kidney swaps are performed by 90 low-volume hospitals scattered across the country.

For that reason, the registry will include an online mentoring program so experienced domino transplant teams can guide and pass along knowledge to other surgical groups.

With help from two newly hired researchers, Dr. Montgomery has sent out questionnaires to hospitals asking them to catalogue their kidney transplant programs, the techniques used and their practices for dealing with patients and donors who are incompatible.

The next step is building a central database.

Medical centers will be able to use the national registry to share information, publicize breakthroughs, critique new procedures and participate in the mentoring program.

According to Dr. Dorry L. Segav, Director of Clinical Research for Transplant Surgery at Hopkins who is working with Dr. Montgomery on the ARRA project, nearly half of incompatible paired kidneys could be matched through a national registry. This would "dramatically cut health costs, reduce disruptive and unnecessary travel for patients and ensure that transplanted kidneys have the best possible chance for survival," he says.

Dr. Montgomery is convinced the registry "will not only save lives, decrease the long waiting list and save the U.S. health care system significant dollars, but it will also stimulate the expansion of transplant centers, tissue typing labs and pathology labs nationwide."

It's an example of how ARRA research grants can produce big dividends for both the nation's health and its economic well-being.

Story attributed to The Johns Hopkins University School of Medicine

This article originally appeared on the Johns Hopkins University website. Reposted with permission.

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  • Clinical Research
  • Kidney Disease
  • Organ Transplantation
  • Transplantation
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