Ms A is a 56 year lady, who experienced kidney failure due to polycystic kidney disease.- the most common serious genetic disease in the UK. After a year on dialysis, she received a live donor kidney transplant from her sister- who fortunately was not affected with polycystic kidneys herself. Her transplant started to work immediately, and she soon felt her health to be much better, allowing her to take more exercise, to return to full time work for an insurance company, and to have the energy to see her adult children and socialise with friends again. In recent months her kidney function has declined slightly, and the doctors in transplant outpatients suggested she undergo a biopsy of her new kidney to identify the cause of the problem. She had this procedure done as an outpatient, which showed that her kidney had features of Chronic Allograft Nephropathy. Mrs A is concerned about what this means for the kidney she received from her sister
What is Chronic Allograft Nephropathy?In the past 3 decades great strides have been made in the treatment of acute rejection- the early process by which the body can attack and destroy a transplanted organ. Unfortunately far less progress has been made in understanding the slower processes over months and years by which many transplanted organs are slowly damaged- even to the point of eventual failure. By identifying its presence, changes can sometimes be made in the combinations of anti-rejection drugs used, with the aim of slowing or halting its progression. Typical appearances seen down the microscope include the loss of healthy tissue, and an increase in the amount of scar tissue seen within the transplanted organ. In recent years there has also been a recognition that there is a change and increase in the number of lymphatic vessels within the chronic injured transplanted kidney – this may reflect the natural response of the kidney to injury- or may even be contributing to perpetuating the damage to the transplant
Mr David Vass is a surgical research fellow working in Centre for Inflammation Research at the University of Edinburgh, studying the natural history of lymphangiogenesis- (the formation of new lymph vessels) in kidney transplants.
As a young medical student David undertook two summer elective projects and was awarded two national prizes for his work, firstly from the Renal Association and secondly from the Pathological Society. This stimulated his interest in research and this motivation and enthusiasm has remained with him. . After qualifying as a doctor David undertook basic surgical training in the West of Scotland gaining experience in general, cardiothoracic and vascular surgery and was successful in passing the membership examination for the Royal College of Surgeons. At this point David decided to pursue his research interest and was appointed as a clinical research fellow obtaining funding by a
research fellowship with the British Transplantation Society to investigate the process of lymphangiogenesis in transplant rejection. David explained “the formation of these new lymph vessels is an exciting discovery in the area of transplantation and we hope that to target these new vessels with new drugs”. This was followed shortly afterwards by obtaining a prestigious clinical training fellowship from Kidney Research UK to take these studies further. David has been appointed to the higher surgical training programme where he hopes to continue his career as a transplant surgeon.
