Improved kidney transplantation outcomes for WA children

Dr Nicholas Larkins is a Consultant Nephrologist at the Perth Children’s Hospital and was awarded a Clinician Research Fellowship in 2019 to develop novel methods to improve successful kidney transplantation in children.

Receiving a kidney transplant is the best treatment for kidney failure, but many eventually fail and people require multiple transplants over time. The main reason for this is ‘rejection’ of the donor kidney by the recipient’s immune system. By better matching the recipient and donor we can avoid some of this rejection, and also make repeat transplantation easier.

During the Clinician Research Fellowship, Dr Larkins compared different ways of matching donors and recipients among Australian children, with the goal of improving long-term outcomes for paediatric kidney transplant recipients. The results also aim to inform clinical practice and policy and reduce the lifetime burden of dialysis for children with end-stage kidney disease.

The results of this project demonstrated that eplet matching can be incorporated into clinical practice, for improvement of the longevity of allografts (i.e., tissue that is transplanted from one person to another) and the ability of recipients to successfully receive further transplants. Furthermore, this project has informed the new Australian Kidney Allocaiton System, implemented by the Ogan and Tissue Authority in 2021. These were the first changes made to kidney allocation in Australia in 20 years. As a result, organ allocation in Australia now more directly incorporates class II HLA matching for young recipients and facilitates national shipping of organs recognising this as a priority.

At a local level, Dr Larkin’s research team has embedded a culture of research within the Nephrology Department at Perth Children’s Hospital. Further research initiatives have arisen from the CRF project, including collaborations with international research groups in the United Kingdom (Cambridge), Netherlands and Belgium. For example, further research is underway to investigate the relative benefit of accepting a maternal compared to a paternal kidney donor, which is a common and important question asked by parents of a child with kidney failure.

Dr Larkins’ research team is now being approached to lead and collaborate on multi-centre trials, giving local children access to novel treatment approaches previously unavailable to Western Australian children with kidney disease. Dr Larkins noted that this expansion in research capacity would not have occurred without the support of the Department of Health and the Raine Foundation, whereby their department has grown to the point that they have a self-sufficient research program with a pipeline of exciting new trials and an array of clinical benefits associated with an active research program.