A team of scientists said they performed the kidney transplant in three children without having to resort to immune suppression. In fact, it is known that although organ donation and consequent transplants save the lives of many people, it is a procedure that brings with it some constraints such as the immunosuppressive pharmacological treatments necessary to keep the immune system under control, to be taken for life. , to prevent the rejection of the transplanted organ.
The results of the new kidney transplant technique were published in the scientific journal New England Journal of Medicine.
Kidney transplant without immune suppression: this is what it consists of
Scientists explained that thanks to a new strategy, kidney transplantation is free from immunosuppressants and associated side effects, which are not always pleasant (and carry an increased risk of cancer and diabetes). The new technique also reduces the possibility that a second transplant will be necessary due to the rejection of the first: “It is possible to safely free patients from permanent immunosuppression after a kidney transplant“, he has declared Alice BertaniaAssociate Professor of Pediatrics at the Stanford University in California.
The innovative technique works by safely transplanting the donor’s immune system into the patient via bone marrow stem cells, before the kidney is activated: double immune / solid or DISOT organ transplantation. This has been tried before, but with limited success. Here an additional process has been grafted: The researchers performed a depletion of alpha-beta T lymphocytes and CD19 B lymphocytes, which meant removing the types of immune cells that cause graft versus host disease or GVHD, a life-threatening complication that was at risk for develop when similar techniques have been used in the past.
With a reduced threat of GVHD, the process was found to be much safer. Removal of alpha-beta T cells is relatively ‘gentle’, which makes it suitable for medically vulnerable children and allows genetically matched transplants in half (from one parent). The removed cells recover naturally in the patient in 60-90 days, reinforcing the immune system again.
Other changes were made in the performance of kidney transplantation, including a reduction in the toxicity of chemotherapy and radiotherapy required prior to transplantation. However, some grueling preparation work is required to knock out the patient’s immune system and prepare the body for receiving a new organ.
The three children who received the kidney transplant in this way have an extremely rare genetic disorder called Schimke’s immuno-osseous dysplasia (SIOD), which limits the body’s ability to fight infections and can lead to kidney failure.
“This extraordinary experience underscores the potential of combined or sequential hematopoietic stem cell transplantation and renal transplantation to correct hematopoiesis and immunodeficiency disorders and to induce renal allograft tolerance.“, They declared Thomas Spitzer And David Sachs of the Massachusetts General Hospital: “SIOD is a rare disease involving immunodeficiency, which has undoubtedly contributed to the achievement of successful engraftment of the donor transplant ”.
Although SIOD and all its complications remain something children have to contend with, it is now all kidney owners who are functioning as they should. The transplants were successful for at least 22 and 34 months, the researchers explained: “These were unique patients where we had to have stem cell transplant and kidney transplant“, Stated Bertania: “They are doing everything: they go to school, they go on vacation, they play sports. They are living a completely normal life ”.
The next steps are to expand the number of patients and the number of conditions for which this might work, as for now it has only been shown in SIOD patients, making them particularly suitable for the procedure.
Of particular interest to the research team are patients who have already undergone a kidney transplant rejected by their body. This unfortunately happens in more than half of cases in children, leading to hypersensitive immune systems that most likely would not accept a second kidney through a normal transplant procedure.
Children will be the first to benefit, then researchers will work until the most advanced age. In the end, the technique could also be adapted to cover transplants of organs other than kidneybut it will take time: “This is a challenge, but not impossible “, concluded Bertania.
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