Do you or someone you love who needs a transplant have a high antibody count? I am a kidney transplant recipient and due to 24 transfusions I had a very high antibody count. The first 2 centers I went to in northern Ca, where I live, told me there was nothing they could do. I was basically tied to dialysis until i died. That all changed when I, through a series of circumstances, found out about high dose IVIG (intravenous immunoglobulin) being done at Cedars-Sinai in Los Angeles. John's Hopkins also uses IVIG in conjunctions with plasmapheresis, but since i live closer to LA I ended up choosing Cedars and it was the best choice I could have ever made. I had one dose of IVIG (typical is up to 4) and then my living donor, my MOM, was able to give me her kidney. This all happened nearly a year ago now, my transplant date was May 16, 2006. So IF you have high antibodies high dose IVIG is the thing for you!!! please feel free to ask me any questions. I'll answer anything, I just want as many people as possible to be free of dialysis!!!
Soraya
THERAPY MODULATES HIGHLY SENSITIZED IMMUNE SYSTEM TO LET MOTHER GIVE
KIDNEY TO DAUGHTER
LOS ANGELES (Dec. 20, 2006) – As the holidays approached last year, Soraya Kohanzadeh, 30,
Muir Beach, CA, was living day to day, extremely ill, with no hope and expecting to live a shortened
life dependent on kidney dialysis. She needed a kidney transplant but because her “anti-donor”
antibody levels were so high, her doctors believed that a transplant was impossible – perhaps ever.
However, thanks to a specialized type of anti-rejection therapy pioneered at Cedars-Sinai Medical
Center, Soraya successfully underwent a transplant in May of this year and has a “new lease on
life” as she looks forward to 2007.
Soraya, was among the estimated 33 percent of kidney failure patients who have high “anti-donor”
antibody levels and who are often told that a transplant is not possible even if a potential donor’s
tissue and blood types otherwise match perfectly.
But on May 16, 2006, she received a kidney donated by her mother, Joan Lando, at Cedars-Sinai .
The transplanted kidney started working immediately, both patients recovered well, and Soraya has
had no episodes of rejection – the result of a therapy that makes the incompatible compatible and
the impossible a reality in many cases.
Soraya had expected to live a shortened life, dependent on kidney dialysis -- a painful, expensive,
time-consuming procedure that cleans blood well enough to maintain existence but not well enough
to contribute to quality of life.
Physicians in the San Francisco area said transplantation was not an option because a donor organ
would be rejected by her hyper-vigilant immune system – a prospect faced by about one-third of the
more than 70,000 patients on the nation’s kidney transplant waiting lists. But Soraya conducted an
Internet search and found that Cedars-Sinai is one of the very few centers in the nation addressing
this problem.
Tissue compatibility issues exist for all patients receiving transplanted organs, but rejection risks are
dramatically increased for those with high exposure to “non-self” human leukocyte antigens (HLAs).
Exposure may come through blood transfusions, previous transplantation or even pregnancy, when
the mother is exposed to the father’s antigens, which are expressed in the cells of the developing
baby. The immune system is then “sensitized” to those antigens – primed with antibodies to attack,
even if the antigens arrive in the form of a potentially life-saving donated organ.
Stanley C. Jordan, M.D., medical director of Renal Transplantation and Transplant Immunology at
Cedars-Sinai’s Center for Liver and Kidney Diseases and Transplantation, pioneered in the late
1980s the use of intravenous immunoglobulin (IVIG) as a way to reduce organ rejection among
highly sensitized individuals. After undergoing years of experiments and clinical trials, IVIG became
a fully accepted, Medicare-approved therapy in 2004 when it was found effective in a multi-center
study partly funded by the National Institutes of Health.
IVIG modulates the immune system without suppressing it. In fact, says Jordan, the therapy
actually boosts the immune system because the antibodies found in IVIG help fend off
infections. For most of their highly sensitized patients today, IVIG therapy is combined with a
new drug, Rituxan®, which brings treatment time down from about four months to one before
transplantation, and the therapy can be used in both living-donor or cadaver-donor transplants.
Soraya says it may have been three or four months from the time she learned about IVIG and
called Cedars-Sinai to the day of the operation. During that time her mother underwent many tests
to make sure that she was as able a donor as she was willing.
“It seemed like it all happened very quickly,” Soraya says. “My mother and I went to Cedars-
Sinai fairly soon after I talked to them and they tested both of us and said, ‘We can do
something for you.’ I just remember thinking, you’ve got to be kidding me. They can solve
everything? And they’ve done it for other people?”
Soraya’s kidneys were healthy until March 2003 when she underwent surgery for a congenital
heart defect and a major vein was accidentally severed. The 24 units of blood she was given
over the next few hours saved her life, but her kidneys suffered irreparable damage, and along
with all those transfusions of other people’s blood came high exposure to non-self HLAs.
Jordan estimates that about 40 percent of Cedars-Sinai’s kidney transplant patients are in the
highly sensitized category, referred to the program – or self-referred – because they could not
be considered for transplantation elsewhere. “We’re able to transplant probably about 95 to 97
percent of the patients we see,” he adds.
Joan’s donor operation was performed by Gerhard Fuchs, M.D., director of Cedars-Sinai’s
Minimally Invasive Urology Institute. He is one of the few surgeons who specialize in
laparoscopic donor nephrectomy, which requires only a few small incisions to remove a kidney
for transplantation. Minutes after Joan’s kidney was removed, a team headed by J. Louis
Cohen, M.D., began the process of placing it into Soraya’s abdominal cavity and connecting it to
her urinary system. Cohen is surgical director of Kidney Transplantation and medical director of
Operating Room Services.
“This time last year, Soraya was living day to day, extremely ill and with no hope. Now she is
back to herself – healthy, cheerful and energetic,” says Joan, 58. “And this is someone who was
told that she was so highly sensitized that she could never get a kidney. We should have been
totally hopeless, but somehow – I don’t know how – we kept thinking there has to be somebody
doing something somewhere. And as it turned out, it was just in L.A. It’s over for us, but to think
that there are other people, just like us, sitting in clinics, who don’t even have a clue.”
Soraya, who used to teach high school algebra, has been able to go back to work as a
volunteer teacher at Marin County’s Juvenile Hall in San Rafael.
“Somewhere between 25 to 30 percent of patients on the kidney transplant list could benefit
from this therapy to help them get transplanted,” says Jordan. “Patients who are on dialysis and
those who are progressing toward renal failure need to know that they have a right to be
considered for a kidney transplant. Their doctor should refer them to a transplant center even
before they start dialysis so that they can be evaluated and the best treatment options can be
determined for them. Patients who have a living donor do not need to be on dialysis before
being transplanted, and the data show that if patients get transplanted before they start dialysis,
they actually do better.”
# # #
One of seven hospitals in California whose nurses have been honored with the prestigious Magnet designation,
Cedars-Sinai Medical Center is one of the largest nonprofit academic medical centers in the Western United States.
For 18 consecutive years, it has been named Los Angeles’ most preferred hospital for all health needs in an
independent survey of area residents. Cedars-Sinai is internationally renowned for its diagnostic and treatment
capabilities and its broad spectrum of programs and services, as well as breakthroughs in biomedical research and
superlative medical education. It ranks among the top 10 non-university hospitals in the nation for its research
activities and is fully accredited by the Association for the Accreditation of Human Research Protection Programs, Inc.
(AAHRPP). Additional information is available at
www.cedars-sinai.edu.
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