Kidney transplantation or renal transplantation is the organ transplant of a kidney into a patient with end-stage renal disease. Kidney transplantation is typically classified as deceased-donor (formerly known as cadaveric) or living-donor transplantation depending on the source of the donor organ i.e. genetically related or non-related transplants, depending on whether a biological relationship exists between the donor and recipient. Generally, patient is on immuno-suppressant drugs after the transplant owning to risk of rejection of kidney by the body. A study revealed a treatment that might not require immuno-suppressant drugs after the kidney transplantation.
Post operation complications and medication
Problems after a transplant may include:
- Transplant rejection ( hyper acute, acute or chronic),
- Infections and sepsis due to the immuno-suppressant drugs,
- Post-transplant lympho-proliferative disorder,
- Imbalances in electrolytes including calcium and phosphate, which can lead to bone problems
Immunosuppressant drugs are used to suppress the immune system from rejecting the donor kidney. These medicines must be taken for the rest of the patient’s life. The most common medication regimen today is a combination of tacrolimus, mycophenolate, and prednisone. Some patients may instead take cyclosporine, sirolimus, or azathioprine.
Avoiding heavy doses of medicines post kidney transplantation
Kidney transplant patients have to take 20 to 30 pills a day, mostly immunosuppressive drugs to stop their immune system from rejecting the transplanted kidney. While this does prolong life, it is not only expensive and cumbersome, there are long term cumulative side effects, including a higher risk of heart disease, infection, cancer and diabetes.
Also, immune-suppressing drugs don’t always work, and the graft deteriorates, leaving the patient back on the waiting list for another kidney transplant or consigned to a lifetime of dialysis.
Dr. Samuel Strobe, an immunologist and professor of medicine at Stanford carried out a study and developed an immune tolerance treatment. He took 12 kidney transplant patients out of which 8 were successfully weaned off their daily immunosuppressive drugs. It will lead to freeing patients from lifelong use of drugs, could reduce long term side effects and bring substantial health-care savings. The studies were being undertaken for the last 30 years.
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How does new treatment avoid immune-suppressing drugs?
Strober and colleagues described that the post-transplant immune tolerance treatment comprises of injections of blood-forming stem cells from the kidney donor, radiation treatment, and antibodies that target the recipient’s own immune system.
They said “a donor-cell infusion of highly enriched CD34+ hematopoietic progenitor cells mixed with CD3+ T cells, and a conditioning regimen of total lymphoid irradiation and anti-T-cell antibodies.”
The radiation treatment carefully targets the patient’s lymph nodes, spleen and thymus to temporarily weaken their own immune systems. Then the patient is injected with stem cells drawn from the donor. These eventually differentiate to team up with the recipient immune system to form one that is now more receptive to the new organ compared to what is seen in conventional post -transplant treatment. Dr. Strober said the recipient’s immune system appears to return to its pre-transplant state of readiness but “casts a blind eye on the foreign tissue of the graft”.
It was observed that the majority of patients were able to discontinue anti rejection medications, and all patients had excellent graft function at the last observation point.
The new treatment for kidney transplant offers a promising treatment with a small study. I think a bigger trial should be conducted to back up the early results, which could ease out the pains of the receipt of kidney transplant.