Kidney transplant patients seek life without drugs

March 19, 2012 By LAURAN NEERGAARD , AP Medical Writer
This photo taken Thursday, March 8, 2012, Lindsay Porter is seen in her home in Chicago. Lindsay Porter's kidneys were failing rapidly when a friend offered to donate one of his. Then she made an unusual request: Would he donate part of his immune system, too? (AP Photo/M. Spencer Green)

(AP) -- Lindsay Porter's kidneys were failing rapidly when a friend offered to donate one of his. Then she made an unusual request: Would he donate part of his immune system, too?

Every day for the rest of their lives, must swallow handfuls of pills to keep their bodies from rejecting a donated organ. The Chicago woman hoped to avoid those problematic drugs, enrolling in a study to try to trick her own immune system into accepting a foreign kidney.

It's one of a series of small, high-stakes experiments around the country that has researchers hopeful that they're finally closing in on how to help at least some go drug-free. The key: Create a sort of twin immunity, by transplanting some of the kidney donor's immune-producing cells along with the new organ.

"I'm so lucky," says the 47-year-old Porter, who stumbled across the research at Chicago's Northwestern University. Porter was able to quit her pills last summer, a year after her transplant, and says, "I feel amazing."

These experiments are a big gamble. If the technique fails, patients could lose their new kidney, possibly their lives. Doctors stress that no one should try quitting anti-rejection drugs on their own.

Why risk it even in a careful scientific study? Anti-rejection medications can cause debilitating, even deadly, side effects, from and infections to an increased risk of cancer and .

Without the drugs, "the hope for me is I'm able to keep this kidney for the rest of my life," Porter says.

Across the country, Stanford University is testing a slightly different transplant method - and hosted a reunion earlier this month for about a dozen kidney recipients who've been drug-free for up to three years.

"These people who are off their drugs, they're cured," says Dr. Samuel Strober, who leads the study of Stanford's approach. "If they have to be on drugs the rest of their life, it doesn't have the same meaning of `cure.'"

Anti-rejection drugs work by ratcheting down the immune system, suppressing it from attacking foreign cells. For decades, scientists have sought ways to eliminate the need for the drugs by inducing what's called tolerance - getting one person's immune system to live in harmony with another person's tissue.

The experimental approach: Transplant the seeds of a new immune system along with a new kidney. It's the 21st-century version of a bone marrow transplant, and possible for now only if the transplanted kidney comes from a living donor.

How does it work? Doctors cull immune system-producing stem cells and other immunity cells from the donor's bloodstream. They blast transplant patients with radiation and medications to wipe out part of their own bone marrow, far more grueling than a regular kidney transplant. That makes room for the donated cells to squeeze in and take root, creating a sort of hybrid immunity that scientists call chimerism, borrowing a page from mythology.

In pilot studies of a few dozen patients, Massachusetts General Hospital, Stanford and a team from Northwestern and the University of Louisville all have reported successfully weaning many, but not all, of their initial participants off anti-rejection drugs.

But each team uses slightly different methods, and it's far from clear which might work best. For example, Mass General patients were weaned off drugs even though their hybrid immunity didn't last - while it persisted for years in the other studies. That might be because researchers transplanted different mixes of cells, or because different pre-transplant treatments may alter how the patient's body reacts.

The question is whether the transplant approach can be made easier and more reliable, said Dr. Laurence Turka of Boston's Beth Israel Deaconess Hospital, who isn't involved in those trials.

"We're at the very early phase of something that has generated a lot of excitement in the scientific community," says Turka, who also is deputy director of the Immune Tolerance Network, a consortium founded by the National Institutes of Health to spur the field. "It has tremendous potential moving forward. Whether it will live up to its potential remains unknown."

To help figure that out, researchers are beginning some new experiments:

-Rather than treating only new transplant patients, the Northwestern-Louisville team is about to begin a pilot study transplanting donor immune cells to people years after they received their new kidney - as long as their long-ago organ donors still are alive and willing to provide those cells.

-Stanford is testing only people with well-matched donors, and hopes later this year to begin the first larger, multi-hospital study of that population. It also is about to begin testing its method in people with poorly-matched donors, like those studied by Northwestern and Mass General. That's important because so many transplant patients lack a well-matched kidney.

-Mass General's study is set to restart soon after some changes to minimize side effects.

Stay tuned: This may not be the only approach. At Emory University, Dr. Kenneth Newell is compiling a registry of truly rare patients - recipients who somehow survive despite quitting the on their own because they couldn't afford them or because of side effects. He's only discovered about three dozen so far. Researchers are testing them for biological markers that might explain why they fared well and who else is a good candidate - and have found clues that a completely separate part of the plays a role.

Explore further: New transplant method may allow kidney recipients to live life free of anti-rejection medication

shares

Related Stories

New transplant method may allow kidney recipients to live life free of anti-rejection medication

March 7, 2012
New ongoing research published today in the journal Science Translational Medicine suggests organ transplant recipients may not require anti-rejection medication in the future thanks to the power of stem cells, which may ...

Irradiation and stem cells used in new treatment to enable kidney recipients to forego immunosuppressant drugs

March 8, 2012
With a novel approach that creates a more-accepting immune system, Stanford School of Medicine physicians have pioneered a technique that frees kidney-transplant recipients from a life on anti-rejection drugs.

Stop taking steroids: Kidney transplant recipients may not need long-term prednisone

January 26, 2012
Rapid discontinuation of the immunosuppressive steroid prednisone after a kidney transplant can help prevent serious side effects, according to a study appearing in an upcoming issue of the Clinical Journal of the American ...

Recommended for you

Pneumonia vaccine under development provides 'most comprehensive coverage' to date, alleviates antimicrobial concerns

October 20, 2017
In 2004, pneumonia killed more than 2 million children worldwide, according to the World Health Organization. By 2015, the number was less than 1 million.

Newly discovered viral marker could help predict flu severity in infected patients

October 20, 2017
Flu viruses contain defective genetic material that may activate the immune system in infected patients, and new research published in PLOS Pathogens suggests that lower levels of these molecules could increase flu severity.

H7N9 influenza is both lethal and transmissible in animal model for flu

October 19, 2017
In 2013, an influenza virus that had never before been detected began circulating among poultry in China. It caused several waves of human infection and in late 2016, the number of people to become sick from the H7N9 virus ...

Flu simulations suggest pandemics more likely in spring, early summer

October 19, 2017
New statistical simulations suggest that Northern Hemisphere flu pandemics are most likely to emerge in late spring or early summer at the tail end of the normal flu season, according to a new study published in PLOS Computational ...

New insights into herpes virus could inform vaccine development

October 18, 2017
A team of scientists has discovered new insights into the mechanisms of Epstein-Barr virus (EBV) infection, as well as two antibodies that block the virus' entry into cells. The findings, published in Proceedings of the National ...

Pair of discoveries illuminate new paths to flu and anthrax treatments

October 17, 2017
Two recent studies led by biologists at the University of California San Diego have set the research groundwork for new avenues to treat influenza and anthrax poisoning.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.