Chemotherapy and Kidney Transplant
A new procedure involving chemotherapy and kidney transplant may prove promising in the fight against organ rejection.
Kidney transplants are one of the most common types of organ transplantation performed in the country. In 2008, 13,156 single kidney transplants were performed. Less than one-half, or 5,968, were from living donors. The survival rate after one year was 97.9 percent. Patients that received cadaveric kidneys had a 94.4 percent survival rate after one year.
The National Kidney Foundation reported in 2008 that 4,573 people died while waiting for a kidney. The 2009 estimate for people listed on the transplant waiting list was 82,364.
Rejection
The greatest problem with kidney transplantation is organ rejection. It is natural for the body to attack any threat to homeostasis and that includes a new organ suddenly placed where a pre-existing organ has been. The immune system is what keeps the body from succumbing to threats from disease and injury.
Anti-rejection drugs, commonly used in organ transplant patients, suppress the immune system. Patients have to take the drugs for the rest of their lives. The drugs are very expensive and, in some cases, are only covered for short periods by insurance carriers. Medicare, for example, covers anti-rejection drugs for 36 months.
A combination of chemotherapy and kidney transplant is being researched to develop an alternative to lifetime rejection drugs.
New Option
Patients facing kidney transplant surgery may have a new option to consider from anti-suppressant drug therapy. According to a new report by ABC News, Dr. David Sachs of Massachusetts General Hospital developed a protocol to deal with organ rejection without the usual anti-suppressant drugs- chemotherapy and kidney transplant.
Dr. Sachs explains that the use of chemotherapy fools the immune system, causing it to recognize the new organ as its own. Chemotherapy kills cancer cells that are in their reproducing stage. When an organ is transplanted it is attacked by the immune cells. Chemotherapy attacks the immune cells that are in a stage of reproduction.
Five days prior to transplant surgery, chemotherapy and radiation are used. Dr. Sachs also transplants bone marrow at the same time as the kidney. Patients remain in isolation for several weeks after transplant surgery in order to reduce the risk of infections. The use of the chemotherapy eliminates any need for future anti-rejection drugs. Chemotherapy treatment can save a patient as much as $12,000 per year, according to the article.
The Boston Globe interviewed Dr. Sachs in 2008 to report how the chemotherapy and kidney transplant procedure was progressing since its inception in 2006. Out of five patients, four had successful transplants without any rejection. The patient that experienced rejection of the new organ received a new drug. He later obtained another transplant that proved successful.
Conclusion
Long term survival for kidney transplants is 50 percent after ten years. Eliminating the anti-rejection drugs can increase the survival rates by giving patients the ability to fight infection. All of the pieces have to fall together; kidney and bone marrow availability with the aid of chemotherapy may be the breakthrough that the medical community has been looking for. The next step is to have the donor roles increase larger than the recipient roles
References
ABC News: New Transplant Method Can Boost Kidney Acceptance
https://abcnews.go.com/WNT/Health/Story?id=2243837&page=1
The Boston Globe:Rejecting defeat
https://www.boston.com/news/local/articles/2008/01/24/rejecting_defeat/
American Cancer Society: How Chemotherpay Works
Kidney Foundation: 25 Facts About Organ Donation and Tranplantation
https://www.kidney.org/news/newsroom/fs_new/25factsorgdon&trans.cfm
