I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: Medical Breakthroughs => Topic started by: Black on July 27, 2006, 08:11:46 PM
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New Transplant Method Can Boost Kidney Acceptance
Patients Recieve Chemotherapy and Bone Marrow in Lieu of Taking Powerful, Often Debilitating Anti-Rejection Drugs
By BARBARA PINTO
July 27, 2006 — At the sound of her coach's whistle, Jennifer Searl launched from the platform into the pool. She was swimming time trials while training for a triathlon, no small achievement considering that until recently Searl could barely walk, let alone swim.
"When I was in college I had to have a handicapped permit because it was too painful to walk," said Searl, now 26.
After undergoing a kidney transplant at age 13 because of kidney disease, she had to take powerful drugs, 25 pills a day, to prevent her body from rejecting the new organ. The drugs, she said, were far worse than the transplant surgery and left her with painful warts on her legs and feet, weakened bones and cataracts.
Even with the medication, Searl's body eventually rejected the kidney.
For her second transplant at age 22, she opted for an experimental treatment that would allow her body to tolerate the new organ without drugs.
Doctors began by using radiation and chemotherapy to weaken Searl's immune system. Then she received both a kidney and bone marrow to regenerate a new, compatible immune system from her donor — her mother.
"We essentially fool the immune system into thinking the donor's organ is part of one's own body," said Dr. David Sachs, who pioneered the surgery at Massachusetts General Hospital.
'It's Been Just a Blessing'
The new kidney transplant procedure eradicates the need for those debilitating anti-rejection drugs that can cost up to $12,000 a year. That type of tolerance has been a long-standing goal for patients and surgeons.
"Tolerance, by definition, means the transplant is being accepted without the need for immunosuppression, and that is the holy grail," said Dr. Benedict Cosimi, a transplant surgeon.
While the procedure using chemotherapy and radiation promises to make patients' lives easier in the long run, there is significant risk upfront. Days before and weeks after the surgery, patients must remain in isolation, because they are vulnerable to dangerous, even deadly infections.
For 24-year-old Christopher McMahon, the fatigue and pain lasted for weeks.
"It's an awful thing to go through," he said. "But the rewards were so great, it kept me going."
McMahon is one of 10 patients who have successfully undergone the new procedure. Four years after his surgery, he is off all medication.
"It's been just a blessing," McMahon said. "I love not having to get up in the morning to have my daily regimen of medicine."
Searl agreed, saying the risk of this procedure is worthwhile for the outcome she now enjoys.
"How I'd like to describe a conventional transplant? I say it's a treatment not a cure. And I feel like this is a cure," she said.
Doctors say this approach, used only in kidney transplants so far, could mean a drug-free life for other organ recipients in the not-too-distant future.
http://abcnews.go.com/WNT/Health/story?id=2243837&page=2
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Now that is what I call GOOD NEWS! That is one of the things that made me not even look into the possibility of a transplant.
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Wow!
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Wow but in all honesty that makes sense! The only thing is not everyone can go through the chemotherapy and radiation! But I would be willing to do that! Too bad it is not available everywhere yet.
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Chemo and radiotherapy are old friends. NO PROB!
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Pretty interesting its coming to pass.
About 4-5 years ago I read that the US Navy was doing research about transplants and bone marrow giving the person a hybrid immune system.
Wasn't sure then or now why the Navy was doing research in this area but as long as it makes progress its all good to me.
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I don't think I would go through the chemo and radiation. I've had my transplant and 18 years of prednisone.......what's 10 more if I were to get another transplant. :P
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That is the thing though. I think this is about never needing a transplant again if the body is tricked into thinking the transplant is your own!
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I don't think this is a guarantee that the kidney will last forever. Beating down the immune system and starting over is really fraught with serious risks that I'm not sure are worth it. A person could very well die just from that before a transplant could even take place. Some transplant recipients develop chimerism spontaneously which means their immune systems and that of the donor somehow merge to become one in ways that are not fully understood. A very few of those people have been able to stop immunosupressants entirely. I volunteered to take part in a study of that in Seattle last month but wasn't able to participate because I don't meet the criteria for minimal immunosupressants required by the study. Still the approach mentioned in the article is interesting and if it can be made to work safely without harming other parts of the body and long term kidney function after it is established then it would be a good thing.
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I don't think this is a guarantee that the kidney will last forever. Beating down the immune system and starting over is really fraught with serious risks that I'm not sure are worth it. A person could very well die just from that before a transplant could even take place. Some transplant recipients develop chimerism spontaneously which means their immune systems and that of the donor somehow merge to become one in ways that are not fully understood. A very few of those people have been able to stop immunosupressants entirely. I volunteered to take part in a study of that in Seattle last month but wasn't able to participate because I don't meet the criteria for minimal immunosupressants required by the study. Still the approach mentioned in the article is interesting and if it can be made to work safely without harming other parts of the body and long term kidney function after it is established then it would be a good thing.
Yes lowering the immune system always presents risks but the medications do that as well. But I must admit I don't know first had how bad it can get with chemo therapy. But I hear it is pretty risky and there is a story in the US about a boy who almost died with chemo. So I know it is not for everyone. I have never heard of chimerism however. That is interesting.
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A chimera was a mythological Greek animal that was a combination of two beings. Chimerism is a medical term that describes a living organism comprised of parts of two or more organisms. Technically all transplant patients are chimeras for that reason. When chimerism is mentioned it is more along the lines of a person or animal whose immune systems have merged and have been accepted by the person or animal. I would like very much to be a chimera! No transplant meds are needed but it is very rare in practice. Seriously chimerism is usually discovered in transplant patients who report stopping their meds but who don't reject as a consequence. Trying this is NOT recommended.
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Yes that is NOT recommended and YES I am speaking from EXPERIENCE!! You see .. I was only 16, went from 98lbs to 128lbs in 28 days .. and I was soooo devastated being a teenaged girl (like any teenaged girl I cared more about my looks than my health!!!) I stopped my meds. Even though I stopped my meds I kept the transplanted kidney (which they said was as perfect as match as any for one not related to me) for 11 years! BUT .. I DID lose the kidney! So you see .. what I did was wrong! And because of that I was denied a transplant for the first few years of dialysis because I was deemed "Noncompliant"! So please ... if you want to stop any medications with bad side effects please talk it over with your Nephrologist and negotiate. Never suddenly stop any medications because of withdrawals as well!!
But yes, if I could have a transplant without the medications I would be so happy! After all, as the nurses in D&T City say, a transplant could be worse than dialysis for some people. You have to be very informed because a transplant is only a temporary measure and is not a cure! It means you have to go under the knife for serious surgery to get a transplant! I remember how hard mine was. But that is another story maybe I will add under the transplant section.
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How long did you stop your meds for? Did you go for years without any transplant meds?
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How long did you stop your meds for? Did you go for years without any transplant meds?
Yes I stopped but it was periodically as my mom made me take them and I did have a semi-rejection (is that what it is called??) so the hospital also gave me medication .. but for years I stopped the Cyclosporine and since I did I couldn't get more ... and it was for years at a time I took no meds
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Then you likely were a true chimera because your kidney did not reject even without transplant meds. In most transplant patients who stop immunosupressants pretty quick rejection would be expected. Just another question what was the cause of the failure of your transplant? Did it just wear out with creatinine and bun creeping up gradually or did you reject at some point?
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Then you likely were a true chimera because your kidney did not reject even without transplant meds. In most transplant patients who stop immunosupressants pretty quick rejection would be expected. Just another question what was the cause of the failure of your transplant? Did it just wear out with creatinine and bun creeping up gradually or did you reject at some point?
At the end I was worn out when my hemoglobin dropped really low. As far as I know it was rejection. They didn't do a biopsy that time. So I don't know for sure. I think they just assumed it was normal rejection since I wasn't keeping up with my appointments.
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One early form of transplantation tried in the 1950s involved extreme bone marrow suppression by radiation, but the procedure carried such a high death rate that it was abandoned. Even today this entire approach is fraught with dangers, some from excessive immunosuppression, some from the extreme debility of the patient in response to the radiotherapy. Another problem too is that the patient now needs not just a new kidney but also a bone marrow transplant, so a second donor source for that has to be found. Finally, there is the danger of graft-versus-host disease, a special type of immological reaction only found in patients with bone-marrow suppression. All in all, the whole procedure is just a tour de force, a demonstration of a medical oddity which can be achieved at an extremely high tech, advanced medical center, but which could never be developed as a general treatment, mainly because of the shortage of bone marrow donors.
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Well then, it would have to be isolated to live kidney donors and use the same person for the bone marrow.
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Well then, it would have to be isolated to live kidney donors and use the same person for the bone marrow.
You've got it. ;)
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Back in 2002 Stanford University Medical Center was doing the same thing with transplants with rejection drugs.
http://www.sciencedaily.com/releases/2002/04/020424072642.htm