Kidney Transplant Update: Resetting Immune System Avoids Rejection

Organ transplantation is a challenging medical solution for each recipient. Before it can save your life, you must survive your immune system attacking your new organ. Thanks to scientific advancements, researchers have discovered an innovative way to reset your immune system to tolerate your new kidney better.

Testing the Resourceful Three-Step Process

Allan Kirk of Emory University in Atlanta, Georgia, led a trial that performed a new for the first time on 20 kidney transplant recipients. Normally, they would have to take up to 20 drugs daily and risk developing kidney failure or cancer as well as bloating and diarrhea. But thanks to the new approach, seven participants need just a single injection each month. The other 13 receive the injection plus one daily pill. Kirk and his colleagues developed the treatment that features three main components. First, they administered Alemtuzumab intravenously during transplant surgery to wipe out lymphocytes (white blood cells) that attack new organs. Lymphocyte numbers recovered over the following 12-18 months, but these cells accepted the kidneys as natural rather than foreign tissue. In essence, this initial step pressed the immune system’s reset button. Then, Belatacept encouraged new white blood cells not to reject donor organs. Drug injections were frequent at first but become monthly six months after transplants.Finally, each patient received a daily Sirolimus pill, a mild immunosuppressant that absorbed any surviving lymphocytes.

Measuring Long-Term Success

A year after surgery, no one in the group had any organ rejection symptoms or needed to take standard post-transplant drugs. At that point, seven subjects complied with Kirk’s request of 10 patients to stop taking their daily Sirolimus. Now they receive just monthly Belatacept injections. Three-and-a-half years after the first transplants, all 20 people in the study continue to do well on the treatment. Kirk’s confident that the effects will be lasting because even subjects on Belatacept alone haven’t produced antibodies that would attack their new kidneys. Other transplant surgeons have hailed this technique as a watershed discovery. “I think it will be a big stride forward, getting tolerance for solid organs,” said Roy Calne, who pioneered simultaneous transplants of multiple organs. “Most of all, it’s a big advance in comfort for the patients.” Calne noted that Kirk’s approach is the mildest and most practical attempt so far to help the body tolerate transplanted organs. Many other methods are much harsher. Some involve body irradiation, and none have matched Kirk’s success rate. Since his first trial, Kirk has treated 18 additional kidney transplant recipients. He’s weaning them off Sirolimus, step three, now. His plans to start a much larger trial are underway. Ultimately, he hopes that Belatacept, step two, will be unnecessary. Kirk looks forward to trying the treatment for other types of organ transplants as well.

Assessing Kidney Rejection Status

Even with immunosuppressive therapy, approximately 10-15 percent of kidney recipients experience rejection within a year of transplantation. Those showing signs of kidney injury undergo biopsies typically. Although serious complications are rare, removing a small piece of kidney tissue to look for rejection-associated damage carries risks such as bleeding and pain. Doctors can’t get accurate impressions of overall kidney states always because biopsy samples are small and may not contain any injured tissue. Investigators at five clinical sites found a better method. They collected urine samples from 485 kidney transplant recipients between three days and approximately one year after transplantation. By assessing three urinary cell levels, the researchers were able to predict or diagnose organ rejection. Molecules indicated the effect or progress, offering an accurate, noninvasive alternative to the standard kidney biopsy. Now physicians can monitor kidney transplant recipients more precisely and routinely. By tracking rejection status over time, they can adjust immunosuppressive drug doses. This important advancement allows doctors to intervene early to prevent rejection and associated kidney injury, improving long-term outcomes for transplant recipients.

Adhering to Immunosuppressant Treatment

Almost everyone who has a transplant must take immunosuppressants every day. A possible exception may occur if an identical twin donated your new kidney. Traditional treatment includes combining Tacrolimus, a calcineurin inhibitor, with other medications. Because of the large number of pills you may need to take daily, forgetting one occasionally is easy to do. But missing even a single dose may make rejection more likely. These three habits can help you remember to take your medicine on schedule:

1. Know the names and purposes of all drugs. If you have a good understanding of your medications, you’ll be less likely to overlook any.
2. Use a pillbox organizer to set up an entire week of medications. Then just take the drugs in each section on the indicated days.
3. Take every medicine at the same time each day. You can set multiple smartphone alarms to remind you when to take each pill.

Recognizing Kidney Rejection Symptoms

Identifying your body’s signs that it’s trying to damage or destroy your new kidney is vital. The National Kidney Foundation recommends calling your doctor right away if you experience any of these rejection symptoms:

• Decreased urine output
• Fever above 100 degrees
• Tenderness in your new kidney
• Bloody urine
• Flu-like feelings
• Weight gain (more than three pounds in two days)

The long-term success of your kidney transplant depends largely on careful follow up and maintaining a good working relationship with your transplant team.