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http://www.newsmax.com/newsfront/Doctors_Report_Transplant/2008/01/23/66909.html
Doctors Report Transplant Breakthrough
Wednesday, January 23, 2008
In what's being called a major advance in organ transplants, doctors say
they have developed a technique that could free many patients from having to
take anti-rejection drugs for the rest of their lives.
The treatment involved weakening the patient's immune system, then giving
the recipient bone marrow from the person who donated the organ. In one
experiment, four of five kidney recipients were off immune-suppressing
medicines up to five years later.
"There's reason to hope these patients will be off drugs for the rest of
their lives," said Dr. David Sachs of Massachusetts General Hospital in
Boston, who led the research published in Thursday's New England Journal of
Medicine.
Since the world's first transplant more than 50 years ago, scientists have
searched for ways to trick the body to accept a foreign organ as its own.
Immune-suppressing drugs that prevent organ rejection came into wide use in
the 1980s. But they raise the risk of cancer, kidney failure and many other
problems. And they have unpleasant side effects such as excessive hair
growth, bloating and tremors.
Eliminating the need for anti-rejection drugs is "a huge advance," said Dr.
Suzanne Ildstad, a University of Louisville immunology specialist who had no
role in the work.
"It still needs some fine-tuning so that everyone who gets treated gets the
same consistent outcome ... It's not the holy grail of tolerance yet," she
cautioned.
The results do not mean that it is safe for current transplant patients to
go off their medicines. Doing so could lead to organ rejection and even
death, doctors warn. And Sachs said the treatment will not solve the
country's organ shortage.
In the 1990s, Sachs showed the treatment could work in a kidney recipient
who was a good genetic match. The woman, who had an organ and marrow
transplant in 1998, has not needed anti-rejection drugs for a decade.
The new study involved five people who got kidneys from parents or siblings
who had slightly different tissue types from the patients. Since many kidney
transplants are similarly mismatched, there is hope more people might one
day be spared immune-suppressing drugs.
The breakthrough has changed the life of a Los Angeles man who was one of
Sachs' patients.
Derek Besenfelder was born with a genetic kidney disease. After a year on
dialysis, he decided to enroll in the experiment and received a kidney and
marrow transplant from his mother in 2005. He took anti-rejection pills for
eight months, but then was weaned from them. He has been drug-free for two
years.
"I wanted to be off the drugs as soon as possible. I had this huge bloated
face and didn't feel comfortable going out in public," said Besenfelder, 28,
who works as a communications director for a Beverly Hills plastic surgeon.
Doctors have experimented with giving marrow before, during or after organ
transplants, while also tinkering with patients' immune systems to prime
them to accept the new organs.
Sachs' treatment involved weakening each kidney patient's immune system with
intravenous drugs several days before the transplant. After the transplant,
the patient got an infusion of marrow from the donor to create a new immune
system.
The stem cells from the marrow reprogram the body by allowing new immune
cells to grow that don't try to attack the donated organ.
The patients took anti-rejection drugs but were weaned several months later.
Four of the five patients developed a hybrid immune system - where recipient
and donor cells live together in the body - for a short time. They were able
to stop taking anti-rejection drugs and had healthy kidney function two to
five years later.
In the one case that failed, the patient had a second kidney transplant and
has been on medications since.
Some researchers such as Ildstad believe the "home run" breakthrough will
come when more people respond to the treatment and keep the mixed immune
system permanently.
Transplant pioneer Dr. Thomas Starzl of the University of Pittsburgh said
donor cells appeared to persist in the bodies of the successful transplant
recipients even if those cells were not readily detected.
As promising as the treatment is, Sachs said it won't solve the country's
organ shortage problem. Nearly 98,000 people are on the waiting list,
according to the United Network for Organ Sharing.
The study was funded by the Immune Tolerance Network, an international
consortium of federal and advocacy groups. Sachs plans a follow-up study
involving 15 to 20 patients at Massachusetts General and other hospitals.
In the same issue of the New England Journal, Stanford University doctors
reported successfully inducing tolerance to a donor organ in a man who was
born with one kidney.
Larry Kowalski, now 50, received a matching kidney and marrow from his
brother in 2005 and was weaned off drugs six months later. He has been off
medications for two years.
Unlike the Massachusetts General cases, doctors said Kowalski has maintained
an immune system from his own cells and his brother's. The research was
funded by the National Heart, Lung and Blood Institute.
Doctors Report Transplant Breakthrough
Wednesday, January 23, 2008
In what's being called a major advance in organ transplants, doctors say
they have developed a technique that could free many patients from having to
take anti-rejection drugs for the rest of their lives.
The treatment involved weakening the patient's immune system, then giving
the recipient bone marrow from the person who donated the organ. In one
experiment, four of five kidney recipients were off immune-suppressing
medicines up to five years later.
"There's reason to hope these patients will be off drugs for the rest of
their lives," said Dr. David Sachs of Massachusetts General Hospital in
Boston, who led the research published in Thursday's New England Journal of
Medicine.
Since the world's first transplant more than 50 years ago, scientists have
searched for ways to trick the body to accept a foreign organ as its own.
Immune-suppressing drugs that prevent organ rejection came into wide use in
the 1980s. But they raise the risk of cancer, kidney failure and many other
problems. And they have unpleasant side effects such as excessive hair
growth, bloating and tremors.
Eliminating the need for anti-rejection drugs is "a huge advance," said Dr.
Suzanne Ildstad, a University of Louisville immunology specialist who had no
role in the work.
"It still needs some fine-tuning so that everyone who gets treated gets the
same consistent outcome ... It's not the holy grail of tolerance yet," she
cautioned.
The results do not mean that it is safe for current transplant patients to
go off their medicines. Doing so could lead to organ rejection and even
death, doctors warn. And Sachs said the treatment will not solve the
country's organ shortage.
In the 1990s, Sachs showed the treatment could work in a kidney recipient
who was a good genetic match. The woman, who had an organ and marrow
transplant in 1998, has not needed anti-rejection drugs for a decade.
The new study involved five people who got kidneys from parents or siblings
who had slightly different tissue types from the patients. Since many kidney
transplants are similarly mismatched, there is hope more people might one
day be spared immune-suppressing drugs.
The breakthrough has changed the life of a Los Angeles man who was one of
Sachs' patients.
Derek Besenfelder was born with a genetic kidney disease. After a year on
dialysis, he decided to enroll in the experiment and received a kidney and
marrow transplant from his mother in 2005. He took anti-rejection pills for
eight months, but then was weaned from them. He has been drug-free for two
years.
"I wanted to be off the drugs as soon as possible. I had this huge bloated
face and didn't feel comfortable going out in public," said Besenfelder, 28,
who works as a communications director for a Beverly Hills plastic surgeon.
Doctors have experimented with giving marrow before, during or after organ
transplants, while also tinkering with patients' immune systems to prime
them to accept the new organs.
Sachs' treatment involved weakening each kidney patient's immune system with
intravenous drugs several days before the transplant. After the transplant,
the patient got an infusion of marrow from the donor to create a new immune
system.
The stem cells from the marrow reprogram the body by allowing new immune
cells to grow that don't try to attack the donated organ.
The patients took anti-rejection drugs but were weaned several months later.
Four of the five patients developed a hybrid immune system - where recipient
and donor cells live together in the body - for a short time. They were able
to stop taking anti-rejection drugs and had healthy kidney function two to
five years later.
In the one case that failed, the patient had a second kidney transplant and
has been on medications since.
Some researchers such as Ildstad believe the "home run" breakthrough will
come when more people respond to the treatment and keep the mixed immune
system permanently.
Transplant pioneer Dr. Thomas Starzl of the University of Pittsburgh said
donor cells appeared to persist in the bodies of the successful transplant
recipients even if those cells were not readily detected.
As promising as the treatment is, Sachs said it won't solve the country's
organ shortage problem. Nearly 98,000 people are on the waiting list,
according to the United Network for Organ Sharing.
The study was funded by the Immune Tolerance Network, an international
consortium of federal and advocacy groups. Sachs plans a follow-up study
involving 15 to 20 patients at Massachusetts General and other hospitals.
In the same issue of the New England Journal, Stanford University doctors
reported successfully inducing tolerance to a donor organ in a man who was
born with one kidney.
Larry Kowalski, now 50, received a matching kidney and marrow from his
brother in 2005 and was weaned off drugs six months later. He has been off
medications for two years.
Unlike the Massachusetts General cases, doctors said Kowalski has maintained
an immune system from his own cells and his brother's. The research was
funded by the National Heart, Lung and Blood Institute.
