Drug-Free Breakthrough In Transplant Patients

[ShotgunSteven]

Great stuff, and between what doctors are able to learn from THIS CASE and these trials, it could be a whole new era in the field of organ transplantation. :thumbsup:

Drug-free breakthrough in transplant patients

A procedure using bone marrow weans kidney recipients off anti-rejection medications which can produce side effects.

By Thomas H. Maugh II, Los Angeles Times Staff Writer
January 26, 2008

Massachusetts researchers have been able to wean four of five kidney transplant patients off anti-rejection drugs, a feat that could eventually lead to a sharp reduction in use of the expensive, side-effect-ridden medications.

By simultaneously giving recipients bone marrow from living donors, physicians were able to induce what is known as a state of tolerance, in which a recipient's immune system does not recognize the new organ as foreign.

The procedure was more remarkable in that the recipients were given kidneys that were not perfect tissue matches, making them more susceptible to rejection.

Based on experiments in monkeys, "there is reason to hope these patients will be off drugs for the rest of their lives," said Dr. David Sachs of Massachusetts General Hospital, lead author of the report in Thursday's New England Journal of Medicine.

The technique will not alleviate the shortage of donors, and patients who have already received transplants will not be able to stop taking medications, but the procedure could have a major effect on transplant recipients if it can be replicated in larger studies.

Anti-rejection drugs can cause a variety of problems, including excessive hair growth, bloating, tremors and kidney failure.

In the new procedure, developed in animals during a 30-year period, the team gave drugs and radiation to prospective recipients to weaken their immune systems and destroy T cells, the primary immune system component involved in tissue rejection.

A few days later, each patient received the transplant and an infusion of bone marrow from the donor. The patients initially received anti-rejection drugs but were successfully weaned off them after eight to 14 months.

The procedure was successful in the first two patients, one of whom has been drug-free for more than five years. The third patient, however, rejected the transplant and had to have a second. Examining the patient, the team observed a high level of another immune cell, called a B cell.

In the final two patients, the transplant team added antibodies against B cells. Both patients were weaned from drugs and have been drug-free two to three years.

Sachs plans to study the procedure in 15 to 20 other patients, and a team at Northwestern Memorial Hospital in Chicago is planning to study it in 20 patients.

 

[dennilfloss]

Excellent.

 

[IGBT]

..anti-rejection drugs have a lot of side effects. this is good news for all.

 

[sonambulo]

Wow, this is really good news.

Originally posted by: IGBT
..anti-rejection drugs have a lot of side effects. this is good news for all.

That's the first thing I thought of as well. It's not even that drugs are expensive or a crutch that's so terrible. The side effects are brutal.

 

[Shortcut]

this is teh shizzle, nizzle

 

[ViviTheMage]

I hear bone marrow is THE WORST pain you will ever feel, when donating.

 

[Ballatician]

i read this day yesterday, very interesting. It took 30 years to test out on animals, this kind of research takes major dedication.

 

[maxster]

Wonder how they solved Graft vs. Host problem when it's not a full match?

 

[moonbit]

Originally posted by: maxster
Wonder how they solved Graft vs. Host problem when it's not a full match?

Hardly any transplants are full matches any more (except bone marrow). They lean very heavily on the drugs to prevent rejections.

At any rate, the way I understand this (and the other article) is that the bone marrow changes the host to match the graft.

 

[RichardE]

Another story I saw a few days ago would fit in this thread

http://afp.google.com/article/...f9ZPhxPRc0vqBgvc9NEFRw

Australian girl switched blood type after transplant: doctors

2 days ago

SYDNEY (AFP) ? An Australian girl spontaneously changed blood groups and adopted her donor's immune system after a liver transplant, in what doctors treating her said Thursday was the first known case of its type.

Demi-Lee Brennan was aged nine and seriously ill with liver failure when she received the transplant, doctors at a top Sydney children's hospital told AFP.

Nine months later they discovered she had changed blood types and that her immune system had switched over to that of the donor after stem cells from the new liver migrated to her bone marrow.

She is now a healthy 15-year-old, Michael Stormon, a hepatologist treating her, told AFP. He said he had given several presentations on the case around the world and had heard of none like it.

"It is extremely unusual -- in fact we don't know of any other instance in which this happened," Stormon told AFP from the Children's Hospital at Westmead.

"In effect she had had a bone marrow transplant. The majority of her immune system had also switched over to that of the donor."

An article on the case was published in Thursday's edition of the leading US medical journal The New England Journal of Medicine.

Brennan's mother Kerrie Mills described the recovery as "miraculous" while the patient herself told a news conference that doctors had given her life back to her.

"I just can't thank them enough. It's like my second chance at life," Brennan said.

Doctors who treated Brennan are interested to know if the case could have other applications in transplant surgery, where rejection of donor organs by the recipient's immune system is a major hurdle.

Stormon said it appeared that Brennan may have been fortunate because a "sequence of serendipitous events", including a post-transplantation infection, may have given the stem cells from her donor's liver the chance to proliferate in the bone marrow, where blood cells develop.

The task now was to establish whether the same sort of outcome could be replicated in other transplant patients, he said.

"The challenge for us now is to try and figure out how this occurred," Stormon said.

One possibility is that the series of events she experienced all weakened her immune system enough for the stem cells to migrate to the bone marrow and proliferate, Stormon said.

These factors include the particular type of liver failure she had, a post-operation infection with the virus cytomegalovirus, and immunosuppressive drugs.

"To try to replicate that is easier said than done," Stormon said, but added the case could still potentially be of crucial importance.

"The holy grail of transplant medicine is immuno-tolerance. She exemplifies that this can occur."

 

[frostedflakes]

Originally posted by: ViviTheMage
I hear bone marrow is THE WORST pain you will ever feel, when donating.

The organs come from dead people, no? I'm sure they won't feel a thing.

Does the marrow have to be injected in a similar way, or can it be done intravenously?

 

[Dragoon42]

i was about to post a link to that girl that got her blood type changed