Double hand transplant patient receives ‘world first’ to stop organ rejection

A double hand transplant patient has undergone plasma exchange treatment in an attempt to stop rejection, in what is thought to be a world first.

Tanya Shepherd, 48, the UK’s first female recipient of a double hand transplant, is being treated by Therapeutic Apheresis Services, Leeds, operated by NHS Blood and Transplant (NHSBT).

She had symptoms of Antibody Mediated Rejection (AMR) – a type of rejection where the immune system identifies the tissue as foreign and produces antibodies to the Human Leukocyte Antigens (HLA) in the donor organ.

Tanya, from Hull, has received ten sessions of Therapeutic Plasma Exchange from NHSBT, where plasma is removed from the blood to quickly decrease or remove the circulating donor specific antibodies, in a bid to stop the rejection.

It is the first known time globally that plasma exchange has been used as a method to treat this type of rejection in a double hand transplant patient.

Initial results suggest that the antibody levels have reduced significantly and Tanya’s symptoms, which included swelling, reduced dexterity and changes in skin pigmentation have begun to improve. Tanya will now begin a different immunosuppressive treatment in the hope of preventing antibody levels from rising again.

Tanya received a double hand and arm transplant at Leeds General Infirmary in September 2018 after losing both hands and three quarters of her left arm to sepsis. She is one of only two cases in the world with AMR of transplanted hands.

NHS Blood and Transplant Medical Director in Apheresis and Gene Therapies, Dr James Griffin, said: “Rejection of transplants can be caused by the development of antibodies against the transplanted tissue. The plasma exchange that Tanya has received from NHSBT’s TAS unit in Leeds, allows removal of these antibodies and other components of the immune system that are causing the rejection process. Our aim is to protect the transplant while other therapies work to stop Tanya’s immune system from making the antibodies and we’re pleased that the treatment has served to ease Tanya’s symptoms and allow her to continue with further treatment.”

 Charlotte Blacklock-Lumb, Lead Nurse at TAS, Leeds, says: “This is the first time that we at TAS have used plasma exchange as a treatment for AMR in a double hand transplant patient and we are delighted to be able to support Tanya in this way. We worked in close conjunction with the hand transplant team, led by Professor Simon Kay, to monitor Tanya as she underwent her initial run of treatment.

“As ever, we are grateful to the many people who donate both blood and plasma and allow treatments like these to take place.”

 Tanya says: “I’m so grateful to the teams at the Therapeutic Apheresis Service, the wider NHS Blood and Transplant and to all of those generous blood and plasma donors that meant this treatment was available to me. Rejection is a real and scary risk for any transplant recipient, but it is reassuring to know that there are treatments that can help – I’m honoured to be the first to trial the plasma exchange for AMR in hand transplants. As always, I encourage people to sign up to become an organ donor and to donate blood and/or plasma if they are able – I’m eternally grateful to those who already have, who have helped me on my journey.”

Health Minister, Andrea Leadsome, says: “Organ rejection is a real risk for transplant recipients and can have devastating consequences.

“NHS Blood and Transplant continues to champion innovative treatments like this world first plasma exchange, allowing people to receive further treatment and live their lives to the fullest.

“If you’re eligible, please consider signing up to become an organ, blood and plasma donor, to support the development of these lifesaving treatments.”

Therapeutic Apheresis Services (TAS) is a part of NHS Blood and Transplant, providing life-saving and life-enhancing services to adults and children across England and North Wales, from eight specialist units: Therapeutic apheresis - NHS Blood and Transplant (nhsbt.nhs.uk)

TAS supports a range of clinical specialities, including: haematology, oncology, nephrology, neurology and rheumatology. Therapeutic procedures offered by TAS include: Peripheral Blood Stem Cell Collection, Lymphocyte Collection, Therapeutic Plasma Exchange, Red Cell Exchange, Platelet Depletion, White Cell Depletion, Low Density Lipid Removal and Extracorporeal Photopheresis.

To find out more about blood and plasma donation and to register as a donor, visit https://www.blood.co.uk or call 0300 123 23 23

 To find out more about organ donation, and confirm your support for organ donation, visit: https://www.organdonation.nhs.uk, call 0300 123 23 23 or use the NHS app.