Eight-year-old Aditi Shankar has become the first child in the UK and on the National Health Service (NHS) to be taken off immunosuppressants just one-month after kidney transplant at Great Ormond Street Hospital (GOSH), London.
This became possible because Aditi had an immune condition for which she received her mother’s bone marrow six months before receiving a kidney transplant for severe irreversible kidney failure. This reprogrammed her immune system to be the same as her donor kidney, so her organ would not attack Aditi’s body.
Multiple teams at GOSH and University College London Great Ormond Street Institute of Child Health (UCL GOS ICH) worked together for many, many months to make this possible, including the Bone Marrow Transplant (BMT), Paediatric Intensive Care, Immunology, Nephrology, Surgical, Anaesthesia and Renal Transplantation teams.
Aditi’s father Uday said: “The team came down from Robin (BMT) ward and let us turn on the machine to deliver her transplant, or ‘my mum’s new cells’ as Aditi says.
“Aditi was different to other children on the intensive care ward, as she was so upbeat and chatty. She would be singing, and that is how the nurses remember her, and we remember each of them for their outstanding care.”
Six months later, in March 2023, Aditi was well enough to have her kidney transplant.
Her father recalls: “A week before the transplant, Aditi went to Guy’s Hospital and visited her mum’s transplant team. On the day itself I raced between Guy’s and GOSH to be with Divya and Aditi. Every half hour I was receiving calls updating me on Aditi’s and her mum’s progress.
“The past three years Aditi’s energy had been lost to dialysis. After her kidney transplant, almost instantly, we saw such a big change in her energy levels. We take our organs for granted, but we all have such a gift in us.”
Just one month after her kidney transplant, Aditi was able to be taken off immunosuppressants as her immune system saw her new kidney as its own. Now back at home, Aditi is thriving. She looks after her new kidney incredibly well, referring to it as a flower that needs water to bloom, much like her plants that she enjoys watching grow.
Dr Giovanna Lucchini, BMT Consultant and Dr Austen Worth, Immunology Consultant, said: "The Bone Marrow Transplant and Immunology teams worked with Aditi and her family for over a year to prepare for the dual transplant. The procedure required unprecedented collaboration between the BMT, Immunology, PICU and Renal teams.
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“The teams had to use all their expertise and some out-of-the-box thinking to sort the scientific, ethical and practical challenges that the case presented. We are absolutely delighted to see how well she is doing, and are incredibly proud to share this success with Aditi and her family. We are already working to see how this breakthrough can underpin further research to help more families.”
Professor Stephen Marks, Clinical Lead for Renal Transplantation at GOSH and Professor of Paediatric Nephrology and Transplantation at UCL GOS ICH, said: “This is the first time I have cared for someone in 25 years who has not required immunosuppression after kidney transplantation.
“We hope that our research will provide the option for more children, like Aditi, for whom kidney transplant was not previously an option, to have the opportunity to have a life-changing kidney transplant.”
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As the first in the UK, it is hoped that Aditi’s treatment success will lead to further investigations in the UK on how bone marrow transplant followed by a kidney transplant from the same living donor could be used to treat more seriously ill children and adults with kidney failure and other conditions. However, this will only be for seriously ill patients who have no other alternative, as the risks associated with a double transplant are greater than that of a regular kidney transplant.
