Transplant Technique Reduces Need
For Immunosuppressive Drugs
NEW YORK, Aug 25 (Reuters Health) -- By blending the
immune systems of an organ donor and recipient, surgeons have
freed a kidney/bone marrow transplant recipient from a life-long
reliance on immunosuppressive drugs. The operation could signal
the advent of transplants performed without the need for these
long-term, risk-laden drugs.
Currently, "the patient is doing very well," said transplant team
leader Dr. Thomas Spitzer of Massachusetts General Hospital in
Boston. "The most remarkable thing about her is she has a normal
kidney and is off all immunosuppressives for close to a year."
Because of the possibility of organ rejection, transplant recipients
are often placed on lifetime immunosuppressive drug therapy that
can leave them open to complications, such as serious infections.
The Boston patient is a 55-year-old woman who developed
multiple myeloma -- a type of bone marrow cancer -- who had
also lost kidney function due to complications from the disease.
In September of 1998, she underwent double transplant surgery,
receiving bone marrow and a kidney from a sister.
As part of the procedure, doctors hoped to instill a state of
'mixed chimerism,' where immune agents derived from both donor
and recipient co-exist within the recipient's immune system.
According to experts, mixed chimerism should allow transplant
patients to maintain healthy immune function while reducing their
risk for transplant rejection.
After her surgery, the Boston patient was placed on standard
immune-suppressive cyclosporine drug therapy. However,
doctors discontinued this treatment after 72 days.
In the August 27th issue of the journal Transplantation, Spitzer's team reports that "174 days following the combined bone marrow and renal (kidney) transplant, and 14 weeks following the
discontinuation of cyclosporine, the patient still has normal renal function."
They also report that "she has achieved a near complete remission
of her myeloma."
"This is a first step toward the day when transplant recipients can be made tolerant to their donors' organs without the risks and costs of life-long immunosuppressive drugs," co-author, Dr.
Benedict Cosimi, said in a statement issued by Massachusetts
General Hospital. "We hope to be able to use this approach with
less-closely-matched donors, providing even more options for
patients needing transplanted organs."
At the moment, the procedure would be appropriate only for
patients who would benefit from both a solid organ transplant and
a bone marrow transplant, Spitzer explained in an interview with
Reuters Health. But the "broader reaching" implication that the
procedure could be used to obviate long-term
immunosuppressive therapy in any patient who needs a solid
organ transplant -- regardless of their need for a bone marrow
transplant -- is being tested and may be somewhere on the
horizon, he said.
Transplantation 1999;68.
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