Organ transplants can save lives, but they also come with strings attached, such as a lifetime of drug treatments to keep the immune system in check, if the organ is rejected as a foreign invader.
Three children in California have had successful organ transplants without the need for immune suppression. A new method was used to minimize the risk of rejection of the new organ.
It means freedom from side effects, which can include an increased risk of cancer and diabetes. A second transplant is less likely due to rejection of the first one.
It is possible to free patients from lifelong immunosuppression after a transplant.
Stem cells from bone marrow can be used to safely transplant the donor's immune system into the patient before the kidneys move over. This has been tried before but failed.
An additional process was added here. The researchers performed an alpha-beta T cell and CD19 B-cell depletion, which meant removing the types of immune cells that cause graft-versus- host disease orGVHD, a potentially lethal complication that has been at risk of developing when similar techniques have been used in the past.
The process was safer because of the reduced threat ofGVHD. The removal of the alpha-beta T cells makes them suitable for medically vulnerable children, and it can be done from a parent. In 60-90 days, the patient's immune system will be back to normal.
There was a reduction in the toxicity of the treatment needed before the transplant. The immune system of a patient needs to be knocked out in order for the body to be ready for a transplant.
The three children given the transplant have a rare genetic disease that can lead to failure of the kidneys.
"This remarkable experience underscores the potential of combined or sequential hematopoietic stem-cell transplantation and kidney transplantation to correct disorders of hematopoiesis and immunodeficiency and to induce tolerance of the kidneys allotransplant," wrote Thomas and David in an accompanying editorial.
SIOD is a rare disorder that involves immunodeficiency, which contributed to the achievement of successful donorHSCT engraftment.
The children have to deal with SIOD, but they are now the owners of the kidneys that are working as they should be. The transplants have been successful for more than two years.
The patients had to have a stem cell transplant and a kidneys transplant.
They go to school, they go on vacation, and they play sports. They are not having any problems.
Since it only works in patients with SIOD, the next step is to expand the number of patients and conditions that this could work for.
The research team is interested in patients who have had a transplant rejected by their body. Up to half of all cases in children will lead to hypersensitized immune systems that won't accept a second transplant.
Children will be the first to benefit from the project. It will take a while for the technique to be adapted to cover other organs.
That's a challenge, but it's not impossible.
The research was published in a journal.
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