9,000 transplants and still counting!

In 2017, the 9,000th transplant supported by the  Histocompatibility and Immunogenetics (H&I) laboratory in Newcastle took place. The one common denominator for these transplants is that the work up is performed by our colleagues in the H&I department.

In 2017, the 9,000th transplant supported by the Histocompatibility and Immunogenetics (H&I) laboratory in Newcastle took place. The one common denominator for these transplants is that the work up is performed by our colleagues in the H&I department.

There are six H&I laboratories: Newcastle, Birmingham, Colindale, Filton, Sheffield, and Tooting. The labs are an integral part of the transplantation process performing Human Leukocyte Antigen (HLA) typing and crossmatching
for a wide variety of transplants.

In Newcastle, organ transplants include kidney, heart, lung, liver, pancreas, and pancreatic islets. Support is also given to a variety of stem cell transplant patients, including one of two centres in the UK supporting children born

The importance of HLA testing was only recognised in the late 1960s when only 20 HLA antigens were known. Today, we know there are more than 8,000 HLA antigens.

The first kidney transplant performed in Newcastle was supported by Patrick Dewar who was working in the tissue typing department for the Blood Transfusion Service. This transplant – led by surgeon Mr Ross Taylor – lasted for more than 25 years, which was remarkable as immunosuppression was in its infancy. This set the foundations for the
transplant programme as it is today. a functioning immune system.

The heart and lung transplantation programme began in 1985 with the first heart patient surviving more than 25 years. This was followed by the first successful single lung transplant in Europe. In 1987, the first successful infant heart transplant in the UK was performed and is still functioning today.

Heart and lung transplantation introduced new challenges for the H&I laboratories. With no time to do a standard crossmatch between organ retrieval and transplant, patients rely on an electronic or virtual crossmatch with patients ‘immunological status’ being determined before an organ is offered.

Once the donor HLA type is known, this is compared against the patient history to determine suitability. Around 80-100 heart and lung transplants are supported per year. The first liver transplant was performed in 1993; now, around 40 patients per year receive a liver transplant. The late 1990s also saw the introduction of pancreas transplantation
and, in 2008, the first pancreatic islet transplantation was performed.

The early 1990s saw the development of three discrete stem cell transplant programmes. These included paediatric immunodeficiency, paediatric malignancy and adult malignancy. Last year, 90 patients received an allogeneic stem cell transplant with support from the laboratory.

Although over 9,000 transplants have now been supported by H&I, the laboratory will have assessed at least three times this number of patients. Some will not have made the transplant list, being either too well or too unwell to be considered.

H&I in Newcastle have been involved in some ground-breaking initiatives in transplantation such as donation after circulatory death (DCD) transplantation, ABO (paediatric cardiac, kidney and adult kidney) and HLA incompatible
transplantation and the first UK en-bloc kidney transplant.

Over 9,000 lives have been changed due to the generosity of donors willing to help others by donating their organs and stem cells: without their gifts and our dedicated, hardworking colleagues (both past and present), none of the
transplants could have happened.

Dr Vaughan Carter, Consultant Clinical Scientist and Head of H&I Laboratory Newcastle, said “The landmark of 9000 transplants in Newcastle is something we are proud of. It is more amazing to think that similar work is being replicated across the H&I function within NHSBT which now results in around four transplants every day. It is great to be part of a team where so many people continue to benefit from the work of a small number of scientists and support staff, whose work and dedication doesn’t always receive the recognition it deserves from the general public.

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    Great work by great colleagues – we in ODT appreciate everything you do to facilitate the donations and save lives through transplantation.
    Best wishes to you on this achievement.

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