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Transforming transplantation

For this year’s organ donation week Pankaj Chandak, Research Fellow at the MRC Centre for Transplantation, King’s College London and The Royal College of Surgeons of England, tells us about his innovative, multidisciplinary work, including 3D printing to support organ transplantation which won him the Royal Society of Medicine Norman Tanner Medal and the Cutler’s Surgical Prize and Clarke Medal for Innovation 2016.

Pankaj shows the 3D-printed models of Lucy's abdomen and her father's kidney. Copyright: Guy's and St Thomas' NHS Foundation Trust

Pankaj shows the 3D-printed models of Lucy’s abdomen and her father’s kidney. Copyright: Pankaj Chandak.

 

Although rates of serious complications have fallen in the last few decades, organ transplants – like any other type of surgery – are not without risks. These risks are related to the procedure itself, the functioning of the transplanted organ and the use of medications that reduce the activity of the recipient’s immune system to stop it rejecting the donor organ.

But these risks are made more uncertain when there is a mismatch between the anatomy of the donor and the recipient – like in the case of a small child receiving an adult-sized organ.

When we were faced with transplanting an adult-sized living donor kidney from a father into his two-year-old daughter, Lucy, I started thinking about how best we could prepare for the surgery. She weighed about 10kg, had kidney failure and had previously received extensive abdominal surgery. After going to a lecture on 3D printing I had the idea of using this technology to support difficult implantation surgery in complex paediatric transplantation.

Working closely with my colleague in medical physics, Nick Byrne, I developed 3D models of the father’s donor kidney and Lucy’s abdomen in order to help plan for this difficult surgery. Based on measurements obtained through computed tomography (CT) and magnetic resonance imaging (MRI) scans, the 3D printer can produce a model by moulding liquid plastic under UV light, to replicate the size and density of a specific body part. These models helped us assess the feasibility of the transplant and rehearse critical steps of the operation.

I developed the idea with my surgical, radiological and medical physics colleagues at Guy’s and St Thomas’ Hospital and we have now performed three successful operations supported by 3D models. We performed the first successful transplantation in November 2015, accompanied by widespread international media coverage. It was quite an experience to discuss surgical approaches with journalists in national newspapers and on live television, including the BBC and Channel 5 News, and I greatly enjoyed promoting our work and sharing our learning for the betterment of patient care. The Science Museum in London have accepted our original 3D models, used in Lucy’s case, as part of their new Medical Gallery as a permanent exhibit which is a huge honour for me and the team.

The 3D models provide an informative, hands-on approach where surgeons can discuss the complexities in a multidisciplinary meeting and also rehearse the steps together. The models have also proved valuable as a training tool for undergraduate and postgraduate students.

Another part of my research is about using new technology to reduce the chance of a donor kidney being rejected by the recipient patient. Sometimes the recipient’s immune system attacks a transplanted organ because it doesn’t recognise it – we are evaluating a cutting-edge technique that might be able to protect donor kidneys against a hostile immune system. The technique involves coating the kidney with drugs prior to transplantation to offer protection against rejection by the recipient’s immune system – using a process called ‘ex-vivo normothermic perfusion’.

It is exciting to see the potential that innovation has to transform healthcare and radically improve the experience of patients like Lucy. Although more work is required to further develop this technique, by combining innovative approaches we hope to minimise the risks of organ transplantation and improve patient safety.

Lister and Faraday are two of my greatest heroes but it is also my patients who continue to inspire me: the children for their innocent courage in the face of adversity and the elderly for the little nuggets of wisdom they share with me on long ward rounds. I begin to understand more about the fragile gift of life when I am surrounded by such courageous individuals. They spur me to carry on even when the going gets tough.

Read more about Pankaj’s research.

Find out about donating your body or tissue to medical research.

Other examples of MRC-funded transplantation research:
Medawar’s legacy: making kidney transplants last longer
video about the pioneers of transplantation, produced by the MRC Centre for Transplantation
Regenerative medicine: An approach using transplantation of stem cells to stimulate repair of damaged tissue, to help patients requiring organ transplants

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