Study seeks to wean certain kidney transplant recipients off anti-
rejection drugs following surgery
After a transplant surgery, anti-rejection drugs for the organ
recipient are a must, but with prolonged use can have serious side
effects, including infections, heart disease and cancer. A team led
by Joshua Miller, MD, a researcher at Northwestern University's
Feinberg School of Medicine, is working with Northwestern Memorial
Hospital's department of organ transplantation to enroll qualifying
subjects in a new research study that seeks to transplant stem cells
from a kidney donor's bone marrow into the recipient, with the hope
of gradually eliminating the need for anti-rejection drugs. If
research proves successful, it would mean a dramatic change in the
post-transplant quality of life for the transplant recipient.
With the debate over how long Medicare should cover immunosuppression
therapy heating up, this also has the potential to save a lot of
health care money by reducing the need for therapies and eliminating
many repeat transplants caused by organ rejection.
Northwestern is one of four centers nationally looking at this topic.
The Feinberg School of Medicine has received a four-year, $2.5
million grant from the National Institutes of Health to enroll 20
patients in the study, which is called "Donor Stem Cells, Campath,
T/B Cell Regulation In HLA-Identical Renal Transplants.
The first subjects to participate in the study underwent kidney
transplant surgery on Jan. 10. Sharon Flood of Pingree Grove, Ill.
donated her kidney to her brother Steven Yelk of Gurnee, Ill., who
suffers from polycystic kidney disease.
Joseph Leventhal, MD, PhD, transplant surgeon, associate professor of
surgery and director of the Living Donor Renal Transplant Program at
Northwestern University's Feinberg School of Medicine, preformed the
kidney donor's surgery and Michael Abecassis, MD, MBA, chief of the
division of transplantation, and dean of clinical affairs for
Northwestern University's Feinberg School of Medicine, performed the
recipient's surgery.
"The surgery was successful, everything went according to plan and
the new kidney is functioning well," said Dr. Abecassis. From here,
the kidney recipient will begin the experimental portion of the study.
This study is open to HLA-identical sibling kidney donor and
recipient pairs. HLA, or human leukocyte antigen, is one of a group
of proteins found on the surface of white blood cells and other cells
that play an important part in the body's immune response to foreign
substances. These antigens vary from person to person, and an HLA
compatibility test is performed before organ transplantation to find
out if tissues match between a donor and a recipient.
The study is limited to only HLA-identical sibling pairs because
these siblings genetically have a more similar set of immunologic
markers than a non-related HLA-identical pair. Because this
population has the closest genetic relationship, they have the best
chance for success with the study. Overall, HLA-identical siblings
have very low rejection rates for kidney transplants but until now
have still required immunosuppressive drugs to be taken for life.
How does it work?
Stem cells are formed at the marrow and are common blood cells from
which other specialized blood cells, like immune cells, develop.
These stem cells are considered important to help prevent rejection
of the kidney transplant. By transplanting these cells from the
kidney donor into the recipient, the study seeks to prove that the
stem cells will mature in the recipient's body and will allow his
immune system to accept the new organ as his own.
For the kidney donor, the laparoscopic surgery occurs in the standard
manner. After the kidney is removed, bone marrow is drawn from the
donor's hip bone. About three months following the surgery, the donor
undergoes two procedures called leukopheresis, happening one day
apart, where stem cells mobilized from the marrow are collected so
that they can be given to the kidney recipient to help his body
acclimate to the transplant.
Approximately one month before the transplant surgery, the recipient
undergoes leukopheresis to draw white blood cells which are stored in
a lab for later testing. After transplant surgery, the recipient
receives four separate inf
The stem cells are infused into the transplant recipient via an IV in
a procedure that lasts about 15 minutes. The first infusion is five
days after surgery, the next is about three months after surgery,
then six months and finally nine months after the transplant. During
this time the recipient is treated with Campath-1H, a potent antibody
used extensively at Northwestern to prevent rejection, in addition to
the other standard anti-rejection medications. About a year after the
surgery, the subject is weaned off of one anti-rejection drug, then
another. There are also ongoing tests to ensure the recipient is
tolerating the kidney.
"This is an exciting area of research which holds a great deal of
promise if successful," says Dr. Abecassis. "We are excited to be the
only center in the region offering this to qualifying patients."
Source:
Source: Northwestern University's Feinberg School of Medicine
Posted Jan. 23
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StemCells subscribers may also be interested in these sites:
Children's Neurobiological Solutions
http://www.CNSfoundation.org/
Cord Blood Registry
http://www.CordBlood.com/at.cgi?a=150123
The CNS Healing Group
http://groups.yahoo.com/group/CNS_Healing
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