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New Transplant Possible Breakthrough!
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New Transplant Possible Breakthrough!

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.

Here's the link to the entire article...

http://tinyurl.com/yt8nnv
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9 Comments Post a Comment
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338734_tn?1377163768
Looks like great possibilities for future. Thanks.
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Avatar_m_tn
I don't think this is as new an approach as it appears. When I was transplanted in 2000 my center was doing this type of procedure with liver transplants. The problem was it was rare for the center to get the bone marrow of the donor in cadaver transplants. I know of one person who was lucky enough to get the bone marrow with the liver but I haven't been in touch for some time so I cannot report on his condition. With a living donor transplant the bone marrow would be available for the transplant. There are other approaches toward the same end that were also underway. I am not sure about this but I seem to recall an approach where they completely shut down the recipient's immune system prior to transplant and when they woke up the immune system would not recognize the organ as foreign. I apologize for not recalling the specifics. And my understanding is that livers are different from other organs when it comes to transplantation. They are more likely than other organs to achieve chimerism, whereby the immune system recognizes both the donor organ and the recipient cell as self.

Here is an abstract from my center from 1996;
1: Clin Immunol Immunopathol. 1996 Sep;80(3 Pt 2):S46-51.Click here to read Links
    The two-way paradigm of transplantation immunology.
    Rao AS, Starzl TE, Demetris AJ, Trucco M, Thomson A, Qian S, Murase N, Fung JJ.
Pittsburgh Transplant Institute, University of Pittsburgh Medical Center, Pennsylvania 15213, USA.
   "The events following organ transplantation require a reciprocal cell interaction which includes both the conventional host-versus-graft reaction and a graft-versus-host component. With all successful transplantation, both graft and recipient become genetic composites. Where donors were available, chimerism has been confirmed in 30-year kidney-recipient survivors, as well as in several liver and lung recipients. A majority of liver recipients have been able to acquire an immunosuppressant-free state after 10-year survival. Animal models suggest that donor-derived cells may exert a tolerogenic effect."

    PMID: 8811063 [PubMed - indexed for MEDLINE]

So, liver transplant recipients are sometimes weened off all immunosuppressive drugs even without the donor bone marrow. I think that this is far more common with livers than with other organs because of the chimerism and it can take a long time to achieve that state of tolerance.

My center has been very aggressive about reducing anti rejection doses and, when possible, eliminating completely immunosuppressive drugs in liver transplant recipients. My dose was reduced drastically in June 2006 and I ran into problems. My surgeon told me that HCV liver transplant recipients present particular problems with aggressive dose reduction and that they have to be much more cautious when attempting dose reduction in those patients.

I also want to comment on a statement from the posted article.

" 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."

The bloated face he complained about is the result of steroids. It is sometimes referred to as "moon face". The use of steroids has been either drastically reduced or eliminated in most liver transplants today so "moon face" is not as common as it once was. When I was transplanted in 2000 I was on steroids for several weeks post transplant and I did have a bloated face for that period. I was then weened off steroids and my face was no longer bloated. Today my center doesn't use steroids for the vast majority of liver transplants so that is not an issue. I mention this because the prospect of transplantation is frightening enough and this side effect of steroids should not unnecessarily increase that fear in anyone who might be in this situation.

Mike
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86075_tn?1238118691
interesting...thanks for this.
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Avatar_f_tn
Did anyone else see this today?  

http://www.reuters.com/article/latestCrisis/idUSSYD906
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131817_tn?1209532911
Did anyone else see the news about an Aussie girl, 15, who had a liver transplant and her body took on the blood type, immune system etc from that organ?  That girl doesn't have to take rejection drugs, she adapted to the liver. Really interesting. Of course they will study her as many docs have been trying to make this happen for ages. Great if they can find a way to make this happen for all with TP.  

Linda
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86075_tn?1238118691
yeah, I saw this...once I got diagnosed, I got addicted to reading a lot of medical breakthoughs, etc, maybe hoping that something will come along for us too...

pretty amazing huh?
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Avatar_f_tn
I saw that and thought WOW! They said it is something like one time in a billion!  But it would be interesting to know what it is her that accepted her transplant.  
The transplant happened when she was  like 6 I think.  So wonder how much age factored into it?
My nurse was telling me the other day there was some sort of good news.
It appears that sheep (yes the ones you count and say baaaa)  have what they might call stupid immune systems, a human liver can be put into a sheep with out it rejecting it.
Where it grows and functions normally. I did not read this, she told me about it, she attends drug comapany research seminars.
She said it sounds promising,  my only concern with it was they do use embryo stem cells.  
Thats another subject though and one I only mention because I asked the question.
Take care!
Debc
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Avatar_f_tn
I saw that and thought WOW! They said it is something like one time in a billion!  But it would be interesting to know what it is her that accepted her transplant.  
The transplant happened when she was  like 6 I think.  So wonder how much age factored into it?
My nurse was telling me the other day there was some sort of good news.
It appears that sheep (yes the ones you count and say baaaa)  have what they might call stupid immune systems, a human liver can be put into a sheep with out it rejecting it.
Where it grows and functions normally. I did not read this, she told me about it, she attends drug comapany research seminars.
She said it sounds promising,  my only concern with it was they do use embryo stem cells.  
Thats another subject though and one I only mention because I asked the question.
Take care!
Debc
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