Vilnius University Hospital, Santara Clinics, has successfully performed the first kidney transplant in Lithuania and the Baltic States utilizing imlifidaze. This enzyme temporarily eliminates antibodies that hinder transplantation. The recipient, 59-year-old Jelena from Vilnius, had been living with hemodialysis for nine years. Due to a highly sensitized immune system, finding a suitable donor had been challenging, despite being invited for transplants multiple times. Her hope for a transplant had dwindled until a timely call and her resolute decision – ‘If not now, then never’ – changed her and her husband Leonid’s lives.
„My wife will turn sixty next month. We received such a gift for our anniversary. The best gift we could have ever hoped for,” her husband shared.
When is Kidney Transplantation Needed?
Dr. Eglė Ašakienė, a nephrologist at the Nephrology Center of Vilnius University Hospital Santara Clinics, explained that kidney transplantation is necessary for end-stage chronic kidney failure, where the kidneys lose about 85-90% of their function, rendering them unable to independently purify blood or maintain vital bodily functions. „Transplantation is a form of kidney replacement therapy, serving as an alternative to long-term hemodialysis or peritoneal dialysis, aiming to restore a good quality of life for the patient. Ideally, the surgery is performed even before dialysis begins (preemptive transplantation).”
Jelena’s Situation – What Made it Unique?
Ten years ago, Jelena was diagnosed with systemic lupus erythematosus. Despite active treatment with immunosuppressants and plasma exchange, her kidney damage progressed. A year later, she began kidney replacement therapy with hemodialysis. According to Dr. E. Ašakienė, Jelena faced a long battle with her illness. „After achieving remission of systemic lupus erythematosus, the patient was placed on the kidney transplant waiting list and became a recipient. Jelena was invited for potential kidney transplants multiple times, but they were impossible due to positive crossmatch reactions,” explained Dr. E. Ašakienė. „Our patient had three pregnancies and received blood transfusions several times. Based on immunological tests, her sensitization was 100 percent. Despite all the years of waiting and medical procedures, we couldn’t find a suitable donor kidney.”
What Does a Complex Immunological Situation Mean?
Extensive immunological tests are conducted before a kidney transplant to identify the best-suited recipient for a donor kidney and minimize rejection risk. Human leukocyte antigens (HLA) on the surface of each person’s cells are inherited markers that the immune system uses to distinguish self from non-self. Therefore, both recipient and donor HLA antigens are identified and their compatibility assessed.
It is also crucial to know if the recipient’s blood contains antibodies against foreign HLA antigens. Such antibodies can form after previous transplants, blood transfusions, or pregnancies. Their levels and composition change over time, so the serum of patients awaiting transplantation is tested approximately every three months.
When a donor is found, a crossmatch test is performed. „This test checks if the antibodies in the recipient’s serum will recognize the specific donor’s cells as foreign. If the reaction is positive, antibodies can damage the transplanted kidney and cause rejection, so an organ from such a donor is usually unsuitable for the recipient. We need to know not only that a patient is waiting for a kidney but also which donor antigens their immune system is sensitive to,” explained Dr. Laimutė Jurgauskienė, a medical biologist at the Clinical Immunology and Transfusion Center Laboratory of Santara Clinics.
Prof. Marius Miglinas: „Imlifidazae – An Opportunity to Transplant a Kidney to a Patient for Whom Finding a Suitable Donor Was Exceptionally Difficult Due to Immune System Peculiarities”
„For patients like Jelena, conventional methods have been exhausted. We attempted to reduce immune system sensitivity, waited for years, but the crossmatch reaction with each donor remained positive. Imlifidazae provided an opportunity we didn’t have before. This enzyme acts like molecular scissors: within hours, it breaks down IgG antibodies in the blood, including those directed against donor tissues. The crossmatch reaction becomes negative, opening a short immunological window for kidney transplantation,” said Prof. Marius Miglinas, head of the Nephrology Center at Santara Clinics.
This treatment was performed for the first time in Lithuania, requiring extensive preparation by the center. „Before undertaking this transplant, we visited leading European transplant centers where imlifidazae is already used. We learned from colleagues how to select patients, precisely plan the timing of drug administration, crossmatch testing, and surgery, and how to monitor the patient post-transplant. Together with immunologists and surgeons, we developed a comprehensive action plan – from calling the patient to the first weeks after surgery,” the professor stated.
According to him, imlifidazae is administered only to strictly selected patients. These are individuals whose blood contains antibodies against almost all possible donors and who would practically be unable to receive a suitable kidney by other means. „The drug alone is not enough. Antibodies can return within days or weeks, making post-operative care crucial. We regularly monitor antibodies and perform biopsies of the transplanted kidney if necessary. We must be prepared to use biological drugs. Such transplantation is only possible in centers with accumulated experience in treating immunologically sensitized patients.”
„Jelena’s story is special to us. It has shown that even patients who have heard ‘impossible’ for years now have a real chance in Lithuania to live without dialysis,” said Prof. M. Miglinas.
Nine Years of Life Revolving Around Dialysis
The exact cause of Jelena’s kidney failure remains undetermined. Doctors did not rule out connections with systemic lupus erythematosus, but the most significant challenge was her complex immunological situation, which severely limited donor kidney searches due to crossmatch reactions.
„When doctors explained the complexity of our situation, they said there were only a few such people in Lithuania. We understood that the transplant would be very difficult,” recalls Leonid.
Jelena was placed on the transplant waiting list, but as the years passed, hemodialysis continued to dictate her daily life.
„My wife has nine years of dialysis experience. There were many difficult days and nights when she couldn’t sleep. Her blood pressure would rise, her legs would ache severely, and other ailments would appear. The fistula, the connection needed for dialysis, had to be operated on more than once. Her arm developed lumps that she wanted to hide even in summer,” her husband recounted.
Dialysis not only affected Jelena’s well-being but also limited the couple’s life. They had to travel for procedures every other day, making spontaneous trips difficult and longer outings require complex planning. „We couldn’t just pack up and go wherever we wanted. We had to find dialysis centers in advance, arrange appointments, and coordinate. Even if we wanted to rest somewhere, everything depended on the possibilities for procedures,” said Leonid.
When the Call for a Transplant No Longer Brought Joy
Jelena had been invited for transplants before. The couple traveled to Kaunas twice, but after tests, it was determined that transplantation could not proceed due to immunological incompatibility.
After such experiences, each new call brought not only hope but also anxiety. „Then we would ask them to check first if it was even worth our while to travel. A person is already tired, and then another journey, tests, waiting, and returning home. After so many years, we had almost lost hope. It seemed we might not receive anything,” admitted Leonid.
However, one day, a phone call brought new hope. This time, Jelena decided not to hesitate.
„When they called and said we could come, at first, we thought – maybe it will be the same story, and after a long wait and countless tests, we’ll have to go home. But my wife said, ‘That’s it, let’s go. If not now, then never.’ And we went. We are returning home with a new kidney,” said Leonid.
The Best Gift for a Sixtieth Birthday
This time, the transplant was successful. The donor kidney transplanted into Jelena began to function, and the initial results, according to Leonid, are optimistic.
The couple expressed their gratitude to the entire transplant team – doctors, nurses, laboratory specialists, and everyone involved in Jelena’s care – for the opportunity to start a new chapter in life.
„We are very grateful to Dr. Eglė Ašakienė, Professor Marius Miglinas, and the whole team. They are true professionals. Everyone took great care of us,” said Leonid.
He extended special thanks to the donor and their family. „We are very grateful to the person who gave a part of themselves to other people, and specifically, to my wife. I went to church and lit a candle for the donor. We are truly very grateful,” the man said emotionally.
Finally – Plans They Had to Give Up
Before the transplant, Leonid had planned a trip to the Canary Islands for his wife’s birthday. He had even found a dialysis center and started coordinating procedures to make the trip possible. However, upon receiving the transplant invitation, these plans had to be abandoned.
Now, the couple can once again consider traveling, something limited for years by the dialysis schedule. „We will definitely go somewhere,” Leonid smiled.
When asked why he so diligently accompanied his wife through all the trials, Leonid answered without hesitation: „I love my wife very much.”
According to Dr. Albertas Čekauskas, head of the Surgical Clinic’s Clinical Group at Santara Clinics, complex kidney transplants are not just a surgical challenge. Their success depends on the expertise of many specialists, meticulous preparation, and the ability to work as a cohesive team. „In this case, close collaboration between transplant surgeons, nephrologists, and immunologists was particularly important. I myself participated in the donor kidney retrieval surgery, which is the first highly responsible surgical stage of transplantation. Over many years, the experience accumulated at our center today allows us to undertake increasingly complex transplants that, until recently, would have seemed difficult to implement. However, the most important aspect is not the medical achievement itself, but the fact that we can provide the opportunity for transplantation even to those patients for whom it was previously inaccessible due to immunological incompatibility.”
Additional information about kidney transplantations at Santara Clinics:
Kidney transplantations are performed annually at Santara Clinics from both living and deceased donors:
2025: 66 kidney transplantations, including 2 from living donors.
2024: 62 kidney transplantations, 3 from living donors.
Living donor kidneys are retrieved laparoscopically or using a robotic system for kidney explantation.
Kidney transplantations are performed from donors whose blood type is incompatible with the recipient’s blood type.
Simultaneous transplantation of two organs – liver and kidney – from the same donor has been performed.
A heart and kidney transplant has been performed.
End-stage renal failure is caused by progressive chronic diseases:
- Diabetes Mellitus: One of the main causes worldwide; diabetic nephropathy irreversibly damages kidney blood vessels over time.
- Arterial Hypertension: Uncontrolled high blood pressure damages kidney arteries and glomeruli.
- Glomerulonephritis: Inflammation of the kidney’s filtering units of various origins.
- Polycystic Kidney Disease: A genetically inherited disorder where cysts form in the kidneys, gradually displacing healthy tissue.
- Systemic Diseases and Vasculitis: For example, systemic lupus erythematosus or inflammation of blood vessels affecting organ systems.
- Congenital urinary tract anomalies.
