By the time Ray Fearing was first diagnosed with a rare kidney disease back in 2000, the damage that had already been done was such that a transplant would eventually be his only option.
"By then, they (the doctors) had noticed there was a lot of protein" leaking from his kidneys, said Fearing, 27, of Arlington Heights. "I think I was at about like 20 percent kidney function when they did my first biopsy, and it deteriorated to 13 percent within a year or two."
Fearing was diagnosed with focal segmental glomerulosclerosis, or FSGS, a disease that causes scarring on the kidney and makes it unable to properly filter waste in the blood. The illness is mostly found in young adults, and about 5,400 people are diagnosed with it each year, according to research advocacy organization NephCure Foundation.
After years of drug therapy to offset the symptoms of his disease, Fearing finally underwent a transplant last June with a kidney that was donated by his sister Cera, 21.
Unfortunately for Fearing, the operation did not turn out as planned. A few days after the transplant, "I started to experience internal bleeding. And they were going to have to take it out," he said.
When rejection occurs, the donated kidney is usually discarded, which takes place in about 9 percent of kidney transplants, according to the National Kidney Foundation. But thanks to an experimental procedure, Fearing was given the option to donate the organ to another candidate. He took that option immediately.
The reuse of Fearing's kidney is regarded by medical experts as the first successful removal and implantation of a kidney into a second recipient after it had failed in the first, which appears to refute previous notions that an organ could only be transplanted once, experts say. The medical findings in Fearing's case were published in the April 26 issue of the New England Journal of Medicine.
Fearing donated the organ to a 67-year-old surgeon and father of five who lives in northwest Indiana.
"When they said there was a chance that I would be able to donate it to somebody else, really the other option didn't seem to be eligible," Fearing said. "I didn't want this to be wasted. It was just not an option to throw it out."
Dr. Lorenzo Gallon, medical director of the kidney transplant program at Northwestern Memorial Hospital, said it wasn't easy to decide to reuse the kidney. One major concern was exactly how the kidney would react in a new host after sustaining damage during the time it was implanted in Fearing.
"I was not comfortable when I made that decision. I was actually very nervous," Gallon said. "If the kidney in the second recipient did not work," the patient might not be able to accept another kidney transplant in the future.
Gallon said once the kidney was implanted in the second recipient, it began to repair itself, becoming fully functional within a few weeks.
One of the major challenges of retransplantation involved coming up with a "plan of attack" to address the limited length of the organ's blood vessels as a result of the kidney being removed twice, Northwestern transplant surgeon Dr. Joseph Leventhal said.
"We knew that we were going to have to reconstruct the blood vessels," said Leventhal, who took part in the procedure. "We took advantage of the fact that from deceased donor organs, we obtain on a regular basis blood-type compatible blood vessels that we can use for vascular reconstruction, and we were able to use these blood vessels to reconstruct the artery and the vein that had been removed from Mr. Fearing."
Dr. Niraj Desai, director of the kidney and pancreas transplant program at Johns Hopkins University Hospital, said the retransplantation of Fearing's kidney not only helped saved a life but could mark a significant step toward better understanding the nature of FSGS.
"Showing that this disease process can be reversed if the environment is correct is important," Desai said. "Not only were they able to help another patient by giving them a kidney that would have otherwise been discarded, but, also, it could be argued that if treatments are adequately done for patients who have FSGS, and you can make the correct environments in that patient, the damage that occurs is reversible."
Gallon said he hopes that with the success of the procedure, kidneys that would have otherwise been thought to be no longer any good to transplant might become available for the more than 90,000 Americans awaiting a new kidney, according to National Kidney Foundation estimates.
"In this day and age, we cannot make a kidney. We cannot make a heart or a liver. We have to rely on a donor to save somebody else's life," Gallon said. "If it doesn't make a difference on a large scale, that's OK, but I think it's quite important to do this sort of approach so that we don't waste even one organ."
Though he was forced to go back on dialysis because his body rejected the kidney, Fearing hopes another chance for a new kidney will come in time. For now, he said, he's content with the idea that his ordeal might one day lead to advancements in the treatment of his disease.
"The one thing that makes me happy is that this is considered a breakthrough that they learned about my disease and kidneys in general from this experience," Fearing said. "Being a part of that lessens the difficulties that I went through because I now know that what I went through will mean something to so many other people."Copyright © 2014, The Baltimore Sun