Research, technology improve survival rates

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Research, technology improve survival rates

By HOLLY TABOR
Saturday, May 5, 2007

Organ transplantation is a complex field infused with scientific and technological advances that continue to be developed. At the forefront of research is the Transplant Center, a program of Jewish Hospital and the University of Louisville School of Medicine.

One of a handful of hospitals performing all five solid organ transplants, the center is the site of Kentucky’s first adult heart transplant, first pancreas transplant, first heart-lung transplant, first liver transplant and first minimally invasive kidney donation.

Research teams there and at other transplant centers around the world continue to search for ways to improve the success rate of transplantation. One area of focus is donor organ acceptance.

Until the 1980s, the potential for rejection limited the number of transplants performed. Thanks to research, Dr. Joseph Buell, medical director of the Transplant Center at Jewish has seen the rate of acceptance improve dramatically. A liver transplant specialist and surgical oncologist, Buell has been transplanting about 12 years.

“When I first started, almost everybody rejected everything,” he said.

Research has helped generate medications called immunosuppressive, or anti-rejection, drugs that help keep the recipient’s body from rejecting its new organ, but these drugs often come with dramatic side effects. The focus now is on finding new, improved medications and developing other methods to keep patients from rejecting a transplant.

Some research hospitals, for instance, use bone marrow transplant as a way to keep the recipient’s body from rejecting the donated organ. At the Transplant Center, doctors are using a subpopulation of white blood cells to “trick the body into not recognizing the organ transplant,” Buell said. The hospital has used the technique in 20 heart and kidney transplant patients and is beginning to use it with liver transplant patients as well.

“What we’re going to do is use new antibodies no one else has used yet,” Buell said.

Additional research is being done in the realm of patient treatment before and after transplant, including identifying candidates for transplantation early and preparing them.

Targeted internal radiation therapy, for instance, is being used in liver cancer patients to shrink or slow growth of the tumor, and even isolate it prior to transplantation. Procedures like this can help the patient remain stable until a donor organ is available � if a donor organ becomes available.

“Our main problem is a shortage of organs,” Buell said.

In 2004, about 25,000 successful organ transplants were performed, according to Kentucky Organ Donor Affiliates. It is estimated that twice as many could have been performed if more people donated their organs.

In addition to supporting organizations that aim to increase the rate of organ donation, researchers are studying ways to improve the care of donors once they have approached brain death, to keep the organs viable as long as possible.

As an alternative, however, they also are working to advance techniques in living related donations, such as allowing a living donor to give one kidney instead of both, or a part of a liver, rather than the entire organ.

“We’re trying to get as many live donors as possible, kidney donors, especially,” Buell said.

Other alternatives include developing artificial organs and tissues and “bridge” technologies, such as ventricular assist devices for heart patients and dialysis for kidney patients, to keep them alive while they wait for compatible organs, according to the National Center for Research Resources.

Stem cells are being studied in search of the potential to regrow tissues and possibly organs, though not without its setbacks and a fair share of controversy. Xenotransplantation, the use of animal organs in humans, still is being researched, though there are too many unknowns to proceed.

“There are all kinds of things (researchers have) tried,” he said. “What we need, obviously, number one, is more organs.”

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