Spain Performs Rare Sixth Kidney Transplant

World Kidney Day, observed every second Thursday of March since 2006, promotes access to health education, healthcare, and kidney disease prevention. A key breakthrough in this field has been kidney transplantation (KT), which has transformed the treatment of end-stage renal failure since the first procedure over 70 years ago.

Spain has long been a global leader in organ donation and transplantation. The country made history in 1965 when the first KT was performed at the Hospital Clínic de Barcelona, a university hospital based in Barcelona, and the Jiménez Díaz Foundation in Madrid, Spain.

Less than a year ago, in August 2024, Hospital Clínic de Barcelona, a nationally and internationally renowned centre, performed Spain’s first sixth kidney transplant on a single patient. This is a rare and technically demanding procedure. Although the hospital had already performed fourth and even fifth transplants, an additional procedure presents an even greater challenge, as surgical complexity increases and survival rates decline, explained Mireia Musquera, head of the Renal Transplantation Section of the hospital, in an interview with Univadis Spain, a Medscape Network platform.

According to Musquera, beyond the surgical challenges, immunologic difficulties also play a critical role in re-transplantation. Patients requiring multiple transplants often need individualised immunosuppressive treatments tailored to their specific case. Graft rejection remains a significant concern, but with current immunosuppression protocols, rejection rates have been reduced to 20%-25% of cases.

“An important aspect of KT is organ preservation from the moment it is extracted until it is implanted,” Musquera stated. Hypothermic perfusion machines have been used for years, although they are not widely used in Spain. Their use has been associated with a reduction in delayed graft function, particularly in kidneys from older donors classified under expanded criteria donors. Delayed graft function has been linked to an increased risk for acute rejection and a decline in long-term kidney function, making organ preservation strategies crucial in transplantation.

Among other clinical innovations in recent years, the introduction of robotics in KT stands out, “which has allowed for the meticulous performance of extracorporeal vascular sutures with excellent functional and aesthetic results,” said Musquera.

According to Musquera, approximately 80% of living-donor KTs are performed annually using robotic surgery at Hospital Clínic de Barcelona. The advantages of robotic surgery include a reduced risk for abdominal wall infections and hernias, fewer postoperative complications, and faster recovery for transplant recipients.

As the hospital emphasises, robotic surgery in this type of transplant has made it possible to introduce minimally invasive surgery to the most vulnerable patients, particularly those with end-stage renal failure.

One of the key challenges in KT remains organ availability for all eligible patients.

“Multiple strategies have been developed to increase the supply, as well as to promote living donation, the use of non-standard criteria kidneys, and expanded criteria donors, whose organs may have some level of damage. She emphasised that raising awareness and encouraging organ donation at a population level is essential to meeting the growing demand for kidney transplants.

This story was translated from Univadis Spain using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.