Kidney transplant patients seek life without drugs

LAURAN NEERGAARD AP Medical Writer Published:




"I'm so lucky," says the 47-year-old Porter, who stumbled across the research at Chicago's Northwestern University. Porter was able to quit her pills last summer, a year after her transplant, and says, "I feel amazing."




Across the country, Stanford University is testing a slightly different transplant method -- and hosted a reunion earlier this month for about a dozen kidney recipients who've been drug-free for up to three years.


Anti-rejection drugs work by ratcheting down the immune system, suppressing it from attacking foreign cells. For decades, scientists have sought ways to eliminate the need for the drugs by inducing what's called tolerance -- getting one person's immune system to live in harmony with another person's tissue.




But each team uses slightly different methods, and it's far from clear which might work best. For example, Mass General patients were weaned off drugs even though their hybrid immunity didn't last -- while it persisted for years in the other studies. That might be because researchers transplanted different mixes of cells, or because different pre-transplant treatments may alter how the patient's body reacts.

The question is whether the transplant approach can be made easier and more reliable, said Dr. Laurence Turka of Boston's Beth Israel Deaconess Hospital, who isn't involved in those trials.

"We're at the very early phase of something that has generated a lot of excitement in the scientific community," says Turka, who also is deputy director of the Immune Tolerance Network, a consortium founded by the National Institutes of Health to spur the field. "It has tremendous potential moving forward. Whether it will live up to its potential remains unknown."

To help figure that out, researchers are beginning some new experiments:

--Rather than treating only new transplant patients, the Northwestern-Louisville team is about to begin a pilot study transplanting donor immune cells to people years after they received their new kidney -- as long as their long-ago organ donors still are alive and willing to provide those cells.

--Stanford is testing only people with well-matched donors, and hopes later this year to begin the first larger, multi-hospital study of that population. It also is about to begin testing its method in people with poorly-matched donors, like those studied by Northwestern and Mass General. That's important because so many transplant patients lack a well-matched kidney.

--Mass General's study is set to restart soon after some changes to minimize side effects.

Stay tuned: This may not be the only approach. At Emory University, Dr. Kenneth Newell is compiling a registry of truly rare patients -- kidney recipients who somehow survive despite quitting the pills on their own because they couldn't afford them or because of side effects. He's only discovered about three dozen so far. Researchers are testing them for biological markers that might explain why they fared well and who else is a good candidate -- and have found clues that a completely separate part of the immune system plays a role.

