When Brenda Quale donated a kidney to Barb Okey last month, she gave her something else: a part of her…
When Brenda Quale donated a kidney to Barb Okey last month, she gave her something else: a part of her immune system.
In a new twist at UW Hospital, some live kidney donors differ with blood stem cells infected in the kidney transplant recipients. The goal is to give recipients double immunity so that they can accept the foreign body without taking lifelong anti-repellent drugs, which are costly and have side effects, including damage to their kidneys.
“It has always been a dream to significantly minimize, if not completely eliminate, these medications,” says Dr. Dixon Kaufman, UW Hospital Transplant Chairman. “We believe this will be transformed into a more sustainable and better functioning kidney transplant.”
Quale and Okey, sisters from Platteville, was the first couple to attempt the new approach at UW Hospital, which is part of a national study.
“Getting away from anti-rejection meds is amazing if I can,” said Okey, 48.
“It will be great if it works,” Quale said, 54. “There is quite a lot to be able to give. “
Almost 35,000 Americans received organ transplants last year from living or deceased donors. In order to keep their bodies from rejecting organs, they take permanent pills to suppress their immune system, which can increase the risk of infection and chronic diseases, and eventually worsen their new organs.
The study of Medeor Therapeutics – a company in San Mateo, California, based on research at Stanford University – replaces the donor’s immune system for anti-repellent drugs.
In Madison, the process began at the end of September when Quale took injections to increase the stem cells in her blood. Nurses collected the cells through a blood filtration machine at UW Hospital.
On November 5, Quale donated a kidney to Okey through a normal transplant.
Okey started on anti-repellent drugs as usual. She also received radiation for 10 days, which is usually not done. The radiation dampened her immune system and prepared her to accept her sister’s cells.
“We partially suppressed Barb’s immune system to create space for Brenda’s immune system, so that both can intermingle,” says Kaufman.
On Nov. On the last day of radiation, Okey Quales immune cells received an intravenous line. The cells had been sent to Medeor for treatment.
Before her infusion, Okey was allowed to stop taking one of three anti-repellent drugs. In a few weeks she ends another. If all goes well, doctors will wean her from the third to six months and completely let it go within one year.
Monthly tests will check if Quale immune systems continue to be in Okey. Usually, recipients receive about 85 percent of their immune system and 15 percent from their donors, says Kaufman.
“As long as there is a part of her sister’s immune system, which is the same as what she donated the kidney, it changes Barb’s system so that it does not reject the kidneys,” he said.
So far, the approach is limited to live sensors and recipients whose tissue types are perfect. Of the 100 or so living donor kidney transplants performed at the UW hospital every year, only four or five perfect matches involve, “said Kaufman.
He works with Dr. Sam Strober in Stanford to customize the technique for partially matched or undue couples. Most of that research is in rhesus monkeys, not humans. Kaufman and Strober are scientific advisors to Medeor.
Similar studies at some other centers infiltrate the donor’s blood stem cells in the recipient prior to renal transplantation. But Kaufman said that afterwards it could eventually work with deceased as well as living organ donors. It is not possible to choose deceased donors and acquire their immune cells in advance, as with living donors.
Quale, a nurse at Southwest Health in Platteville and Upland Hills Health in Dodgeville, was not worried by giving up immune cells along with her kidney. The cell-stimulating injections made her feel that she had the flu, and she had a lot of discomfort after surgery.
Okey is grateful that Quale, one of her four siblings, was medically and emotionally suitable to help.
“I will not lie.
Okey developed an inflammatory kidney disease almost 20 years ago. Last year it suddenly became worse, which led to her doctor saying she needed a transplant.
The conditions meant that she kept water and got her arms and legs to swell. She got so tired that she could barely do it all day without sleeping. Even so, she continued her job in the laundry department in a residential building.
Now, though she continues to recover from her transplant, she already feels better.
“I have more energy than I did before,” she said. “I can be awake all day.”