A Life Free From Anti-Rejection Medication Post-Transplant?

A life free from taking anti-rejection medications post-transplant…is it possible? After transplant, patients must take multiple medications to keep their bodies from rejecting the new organ. The side effects of these immunosuppressant drugs, for many, can be grueling. Side effects range from fatigue to high blood pressure to increased risk of infection. Researchers are currently evaluating whether it’s possible for kidney transplant patients to avoid use of immunosuppressant drugs post transplant. They’ve found that it’s possible that by not only transplanting the living donor organ but also some of the donor’s immune producing cells, it  may be possible to deceive the recipient’s immune system into accepting the new organ as its own.

To evaluate the likelihood of decreased reliance on immunosuppressant drugs for kidney transplant patients, researchers collect immune system-producing stem cells and other immunity cells from the living donor’s bloodstream. They infuse transplant patients with radiation and medications to wipe out part of their own bone marrow.  This allows the donated cells to squeeze in and create a sort of ‘mixed’ immunity that prevents rejection.  In essence, a kidney transplant patient would also be receiving a bone marrow transplant.

Dr. Kenneth Newell

Dr. Kenneth Newell

At the Emory Transplant Center, researcher Dr. Kenneth Newell, is compiling a registry of kidney recipients who somehow survive despite quitting the pills on their own because they couldn’t afford them or because of side effects – a truly rare case.  Thus far, Dr. Newell has discovered about three dozen of these cases.  The research team at Emory is testing these patients for biological markers that might explain why they fared well and who else is a good candidate.  This may provide clues that a completely separate part of the immune system plays a role in organ rejection/acceptance.

In the meantime, the Food and Drug Administration (FDA) approved the drug belatacept (Nulojix®) for the prevention of graft rejection after kidney transplants.  This is the first time a new class of drugs has been developed for transplant since the 1990s.  Belatacept has the potential to improve and simplify the medication regimens of kidney transplant recipients, being a less toxic alternative to calcineurin inhibitors, with fewer side effects such as high blood pressure, high cholesterol, kidney toxicity and diabetes.  It is now being offered at the Emory Transplant Center, where Emory physicians played a role in discovering this new drug.

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