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Dialysis Discussion => Dialysis: News Articles => Topic started by: okarol on December 26, 2010, 03:09:59 AM
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Tucson hospital raises transplant hopes
Associated Press | Posted: Saturday, December 25, 2010 12:08 pm |
Nicole Drissi was ready to stop the 11 hours of weekly dialysis that was keeping her alive.
Debilitated by the diabetes she'd had since childhood, the 29-year-old's kidneys had failed, and she passed out so often because of a diabetes-related condition that she knew many local paramedics on a first-name basis. A pancreas transplant in 2008 failed and since then, her body had been producing so many antibodies that she wasn't a candidate for another transplant.
But now, not only is Drissi off dialysis, she's no longer diabetic because of doctors at University Medical Center in Tucson. They were able to lower her antibodies through innovative immunotherapy, and Drissi got a new pancreas and kidney in September.
Three years ago, that therapy wouldn't have been available in Tucson.
But since nephrologist Dr. Bruce Kaplan came to Tucson from the University of Illinois-Chicago in 2008, patients who were previously ineligible for transplants because of high antibodies are getting another chance.
Kaplan, medical director of transplant services at UMC, is leading a randomized trial on the powerful biologic agent he used to treat Drissi _ bortezomib.
"She wanted the transplant so bad and you know, (without it) she probably would have died in a few years," Kaplan said.
About four or five medical centers in the country are using the drug for immunotherapy in transplant candidates, he said.
"I've been shocked at the success rate. I'm the biggest cynic in the world," Kaplan said. "I've been amazed at how well the drug works. But it's still anecdotal. I don't have proof, anything I can publish until we do our randomized study."
Kaplan got Drissi ready for surgery by bringing her antibodies down through 12 grueling rounds of bortezomib, which left her sick and weak and resulted in hair loss. But the drug had the positive and unique effect of working directly against the plasma cells, the cells that make the antibodies.
"We gave her the most I've ever given anyone in my career. I usually limit it to four (treatments)," the doctor said. "But Nicole, we did 12, and to this day she still has no antibodies."
Drissi is covered by a blend of government insurance _ Medicare disability and the Arizona Health Care Cost Containment System, which is the state's form of Medicaid.
Though the surgery was successful, Drissi suffered setbacks, including going into cardiac arrest several days after the operation. She spent 34 days in the hospital.
Kaplan says bortezomib is a new drug and doctors don't know the long-term effects. Peripheral neuropathy _ painful hands and feet _ is one effect that Kaplan worries about.
But Drissi says she has no regrets. "If I had to go through it all over again, I definitely would," she said.
Drissi will be on anti-rejection drugs the rest of her life and may need another transplant in about 10 years. But many medical advances could occur in that time, said Dr. Rainer Gruessner, chief of abdominal transplantation at UMC.
Drissi hopes to earn a medical degree in her late 30s and then have a long career helping kids.
While just a handful of patients at University Medical Center have had bortezomib therapy, several other pre-transplant patients have gone through desensitizing therapies led by Kaplan.
This year at UMC, for example, 46-year-old Yuma resident Gustavo Chavez underwent his fifth kidney transplant after getting drug treatment with Kaplan to reduce his antibodies.
Because Chavez had so many transplants in the past, his antibodies and risk of infection were high.
His most recent transplant was from a living donor, his brother. And doctors believe it may be the last time he needs a new kidney.
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Information from: the Arizona Daily Star, http://azstarnet.com/
http://azstarnet.com/news/state-and-regional/article_38d4355e-a852-577d-a8b4-a2cd5001e185.html