First child kidney transplant in Spain from different blood group donor

by Lorraine Williamson
first child transplant operation with incompatible organ

For the first time in Spain, a so-called incompatible organ transplant was performed on a young child in a hospital in Barcelona. In these types of complicated transplants, the blood group of the recipient and that of the donor are not a match.

The operation, carried out in Clínic y Sant Joan de Déu, was successful.  And 8-year-old Candela from Espluges de Llobregat is now doing well. At the age of two she was diagnosed with severe kidney disease. And at the age of four she received her first donor kidney. However, her body rejected this kidney. Subsequently, it produced so many antibodies that the chance of finding a new kidney was virtually non existant. Therefore, Candela had to undergo kidney dialysis for four years.


In December last year, her doctors decided to perform and incompatible organ transplant. Which, according to medical director, Antoni Castell of the hospital in Barcelona, would be an “extraordinary scientific, technological and human milestone”.

In order to find that `needle in the haystack´, Candela´s data was entered into the search system of the Spanish National Organisation for Organ Transplants (ONT). The algorithm required adjusting so that suitable organs from someone with an incompatible blood group would also appear.

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High risk of rejection

This found a kidney from a Seville donor, which was immunologically matched to Candela´s body, but had an incompatible blood type. Due to the high risk of rejection, these incompatible organ transplants have not been performed for very long. According to ONT director Beatriz Domínguez Gil, only 255 such operations have been performed in Spain since 2011, and so far, only on adults. Before Candela´s successful surgery, a 16-year-old girl was the youngest recipient from an organ of a donor with an incompatible blood type. This transplant took place in La Paz hospital in Madrid.

Cross-over transplant donation

The transplant performed on Candela was a so-called cross-over donation. Candela´s father himself was not a suitable living donor for his daughter. In such a case, a comparable donor-recipient couple is sought and the organs are exchanged, as it were. For example, Candela´s father´s kidney was transferred to Candela´s donor in Seville. And Candela received the kidney from this donor. The longest donor chain to have taken place in Spain consists of six transplants.

In the case of an incompatible organ transplant, the recipient will receive immunosuppressive medication in the period before the transplant. The body then breaks down the antibodies against incompatible blood groups. This also makes the recipient more susceptible to infections or other illnesses. Candela also had to make the donor organ from an adult man suitable for an 8-year-old girl. After  the transplant, Candela suffered internal bleeding, which required re-surgery. After several tense days, she recovered and after three months of surgery, no longer needs dialysis. The corona pandemic has kept her out of school due to the risks. However, otherwise Candela is able to lead a normal like again.


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