For patients who undergo kidney transplants, lifelong immunosuppression via medication is needed to ensure their immune systems do not reject the new organ. This complication is the most common reason patients require second transplants, while immunosuppressive drugs also carry their own increased risks of cancer, diabetes, and infections.
However, pediatricians at Stanford Medicine have now developed a method of carrying out kidney transplants in immuno-suppressed children using stem cells from parents, negating the need for these drugs.
Three children have undergone the procedure so far, all of whom had a rare genetic disease called Schimke immuno-osseous dysplasia, an immune disorder. The case series was published in the New England Journal of Medicine today.
The patients first received bone marrow stem cells from parents, then, five to 10 months later, underwent a kidney transplant.
“They’ve healed and recovered, and are doing things we never thought would be possible,” said parent Jessica Davenport in a statement, whose two children were among the three patients to undergo the procedure.
One child received transplants from Jessica, and the other from their father. All patients no longer have Schimke immuno-osseous dysplasia and have been living for 22 to 34 months.
Although previous research into stem cell transplantation revealed a potential risk of graft-versus-host disease, the team at Stanford was able to refine the process by which the donor’s cells are processed, greatly reducing this risk.
Patients requiring a kidney transplant are also often put on waiting lists until a donor match is found. But with this new method, safe transplantation between a donor and recipient whose immune systems are genetically half-matched, or parents, could significantly cut down wait times.
In addition, organs donated under current protocols may only last for one or two decades before they need to be replaced. With the new procedure, the stem cell transplant effectively trains the body to not reject a subsequent donation, although it is unclear whether the kidneys will last a lifetime.
The protocol was approved by the FDA in May 2022. Researchers hope to expand their work into a wider patient population and investigate whether the method could be used for other solid organ transplants.
However, they caution the procedure is not a cure for Schimke immuno-osseous dysplasia and since receiving transplants, patients have suffered adverse events including migraines and increased risk of stroke and cardiovascular problems.
“The Holy Grail of transplantation is immune tolerance,” said Amit Tevar, surgical director of the Kidney and Pancreas Transplant Program at the University of Pittsburgh Medical Center in a statement. Tevar, who was not involved with the research, described the findings as “ground-breaking.”
Published on Jun. 16, 2022