Spain and Italy perform fourth international cross transplant in mid-third wave of coronavirus

In mid-third wave of the COVID-19 pandemic, a Spanish patient and an Italian patient received a living donor renal transplant, thanks to swapping organs between their respective donors with whom they were incompatible. Donors and recipients are in a perfect state of health and have now been discharged.

Both the renal extractions and the transplants were performed on the same day at the Malaga Regional University Hospital and the Fondazione Policlinico Universitario Agostino Gemelli IRCSS in Rome. Both the donors and recipients tested negative for SARS-CoV-2 after taking a PCR test before the procedure. The surgeries began at the same time in the two hospitals, specifically at 9 am. The plane with the fridge that transported the organ from the donor in our country left Malaga at 11:07 and landed at Roma Ciampino Airport at 13:45. There the graft was collected from the donor in Italy and departed for Malaga just a few minutes later, at 13:54. The implant was completed in Italy at 18:00 and in Spain two hours later. This whole complex procedure was coordinated at all times by the ONT in collaboration with the Italian National Transplant Centre, which provided support to the two teams.

Cross Renal Transplant Programme

The cross renal transplant programme is based on exchanging living kidney donors between two or more couples. Its aim is to offer patients with chronic renal insufficiency the possibility of receiving a graft from a living donor, despite incompatibility with their partner or other family members. By exchanging donors, new donor and recipient pairs are formed that are compatible with each other. The ONT introduced this programme more than a decade ago. The first cross renal transplant in Spain took place in July 2009. Since then, 255 transplants of this type have been performed in our country under the National Programme.

Cross renal transplant is a highly developed therapeutic modality in certain countries with high levels of renal transplant activity from living donors. This is the case of Australia, Canada, South Korea, the United States, the Netherlands and the United Kingdom, which have been performing this kind of intervention for some time with excellent results.

Internationalisation of the Programme

Cross renal transplant is a complicated logistical process, made even more so by its internationalisation, which requires full collaboration between the central offices of the respective national transplant organisations of Spain and Italy, the regional transplant coordination offices and the medical teams of the participant hospitals. On this occasion, since the professionals involved were unable to meet in person, all of the preparations were carried out electronically. Just 13 weeks elapsed between the ONT crossing the data and detecting the compatibility between the two couples and the performance of the transplants. The most suitable date was chosen in light of the epidemiological situation in the two countries, and specifically at the centres involved.

In this fourth successful cross transplant of the international Cross Renal Transplant Programme - one with Portugal and three with Italy - 10 Spanish hospitals, seven Italian hospitals and one Portuguese hospital (see Table 1) have participated, with a total of 114 donor-recipient couples who had been unable to find the right swap in their own country: 62 in Spain, 31 in Italy and 21 in Portugal.

The entire process coordinated by the ONT

The ONT, which coordinated this operation at all times, contributed its experience in this type of transplant and the IT platform that allowed the possibilities of the exchange between the couples recorded in the International Register to be analysed. Each year, the ONT promotes three crosses between the participant countries (Spain, Italy and Portugal) in which the couples are included that have been unable to find a possible swap within the individual programmes in their own country. France, Greece and Switzerland are also interested in this Programme, and may shortly sign up to it, which would mean an even greater chance of achieving renal swaps.

The ONT is also commissioned with managing the crossing of couples, with informing the participant countries of the potential combinations detected and with drawing up an annual report on the results. To carry out this mission, the web platform of the ONT's Cross Renal Transplant Programme has been adapted, which contains the information on all incompatible donor-recipient couples and seeks combinations through a mathematical algorithm. This platform is located at the ONT's headquarters and its staff are tasked with its maintenance and administration.

Ministerio de Sanidad

Non official translation