Transplants without the anti-rejection drugs?
Study looks at boosting a patient's immunity
Lindsay Porter’s protruding belly wasn’t due to pregnancy; her kidneys had swelled to eight pounds a piece. She had polycystic kidney disease (PKD) and needed a transplant. She wasn't scared of the surgery, but something did frighten her.
"It was really the medications."
The anti-rejection drugs she would have to take for the rest of her life and the other medications to help with the possible side effects of those drugs. Lori Felber knows all about that.
Nine pills a day, 3,285 pills a year: That’s what she’s had to take since her kidney transplant in 2008. She's grateful her husband was able to save her life by donating his kidney, but doesn’t want to take expensive drugs all the time.
Today, that's Lindsay’s reality. She took part in a pioneering study at Northwestern University. It involved 18 kidney transplants -- where the unmatched, unrelated donors gave more than kidneys to the recipients. They gave their stem cells.
"The results have been remarkable," said Dr. Joseph Leventhal, an Associate Professor of Surgery and Director of Kidney and Pancreas Transplantation at Northwestern University.
He says the idea is to create chimerism or two immune systems in the recipient.
"Right, so you have peaceful co-existence, if you will, of the donor's stem cells with the other aspects of the recipient's immune system."
To make that happen, Lindsay had chemotherapy and radiation before the transplant to weaken her own immune system. The day after her transplant, engineered stem cells from her donor were infused into Lindsay’s body. Days later, she had one more chemo session.
"I was on the medications for about six months before they started weaning me off of it," Lindsay explained.
Unlike Lori -- who faces a lifetime of medications and potential side effects -- Lindsay was off all the drugs after just one year. Leventhal says most recipients who went through the procedure had similar results. While there was a risk of the injected stem cells reacting against their bodies, none experienced that.
"It may reshape the landscape of how we do transplant over the next decade," Leventhal said.
With a healthy kidney and no more anti-rejection drugs to take, Lindsay’s free to spend her time with her son.
"I'm so glad that I've had the last two years to really be with him 100 percent."
Lindsay says the procedure cured her of her high blood pressure, and her blood type changed to the blood type of her donor. The transplant study she was involved in is ongoing. A second trial is also being planned. It will offer a similar treatment to people, like Lori, who've already undergone a living donor kidney transplant.
For more information on the study, go to transplant.nmh.org or call (312) 695-0828.
TRANSPLANTATION: Organ transplantation is the surgical removal of an organ or tissue from one person and putting it another. Organs that can be donated include the kidney, heart, liver, lung, pancreas, and intestine, but tissues such as bone, cartilage, and the cornea can also be transplanted. With about 4,100 transplant candidates added to the national waiting list each month, the number of people in need of a transplant is rising faster than the number of donors. Although around 77 people a day receives transplants, there are also about 18 that die waiting due to the shortage of donated organs. (Source: www.womenshealth.gov)
CARE AFTERWARDS: After a transplant, most people need to take a lot of medications. These medications include immunosuppressants, which stops the body from rejecting the organ. Other than the annoyance of having to take multiple pills for the rest of their lives, the immunosuppressants may also make the person more likely to get infections and make it harder to recover from some infections and illnesses. Patients will continue to have their health monitored by their doctor for many years after the surgery as well. (Source: www.womenshealth.gov)
DONATION: Most of the donated organs and tissues come from people that have already died but living people can donate a kidney or a part of their liver, intestine, pancreas, and lung as well. Becoming an organ donor is a personal decision and there are many reasons why some people decide not to donate. For living donors, the operation can be risky and for those who have died, religious views may stand in the way. Disease or a medical condition will not exclude a person from donating, but here are some medical conditions that mean a person cannot donate:
- Actively spreading brain cancer
- Certain severe, current infections (Source: www.womenshealth.gov)
NEW TRANSPLANT THEORY: The new clinical trial by researchers from Northwestern Medicine and the University of Louisville is hoping to ‘trick’ the recipient’s immune system into thinking that the transplanted organ is a part of the patients natural self so the need for anti-rejection medication will be reduced or eliminated gradually. A month before the transplant, bone marrow stem cells are collected from the kidney donor’s blood, then sent to the University of Louisville where researchers enrich for “facilitating cells” believed to help transplants succeed. At the same time, the recipient undergoes chemotherapy and radiation to suppress bone marrow in order to make room for the donor’s stem cells to grow. The day after the transplant, the donor’s stem cells are put into the recipient and hopefully the two systems exist and function in one person. So far, results have been good. (Source: www.northwestern.edu)
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