After a kidney transplant, patients are dependent on medication for the rest of their lives to prevent their bodies from rejecting the foreign organ. This weakens your immune system. A new procedure could change this. The University Hospital Zurich was the first clinic in Europe to transplant not only her brother’s kidney but also parts of his immune system into a patient. The woman has now been living entirely without immunosuppressive medication for more than a year.
If the kidneys no longer function and the toxins are no longer filtered out of the blood, the only option is dialysis or a kidney transplant. However, in order for the foreign organ to be accepted by the body, the patient’s own defenses must be strongly suppressed in the form of immunosuppressive drugs.
As a result, immunosuppressed patients are significantly more susceptible to infections of all kinds, which generally reduces their quality of life. It is particularly serious that almost every second recipient of a foreign organ will develop cancer during their lifetime. “The many infections and cancers among organ recipients are to a certain extent the price we pay for progress in transplant medicine,” says Thomas Fehr, Head of Internal Medicine at the Cantonal Hospital of Graubünden and consultant physician at the University Hospital of Zurich.
A completely new approach developed in the USA tackles this problem at its root: Patients are not only implanted with the foreign organ, but also with a part of the donor’s immune system in the form of bone marrow stem cells. The initial burden of the therapy is naturally greater due to the double transplantation. However, the additional burden is worthwhile for the recipient, as the medication can be reduced quickly and eventually possibly discontinued altogether.
The University Hospital Zurich recently became the first clinic in Europe to successfully apply this procedure. Two patients were transplanted as part of a clinical trial based on the results from the USA. The first patient has been living without any immunosuppressive medication for more than a year. In the second patient, the transplant was less recent; she only needs a single medication.
The effect of the new procedure had previously been investigated in various constellations in a broad-based study at Stanford University. The best results were achieved when the kidney and stem cell donor was a sibling. In this group, immunosuppression was completely reversed in 16 out of 22 patients. However, much more research is needed before the new method becomes an option for anyone who needs an organ. This is because at present, not only does a sibling need to be willing to donate, but also their immunological match – which only applies in around one in four cases. For this reason, the clinical study is being continued at the University Hospital Zurich with the aim of making the new procedure applicable to a larger number of patients.