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Monday, 26 August, 2002, 22:44 GMT 23:44 UK
'Drug-free' transplant hope
Doctors hope to end the need for anti-rejection drugs
Doctors hope to end the need for anti-rejection drugs
Doctors are developing ways of eliminating the need for transplant patients to take anti-rejection drugs.

The immunosuppressive drugs help the body accept a donor organ, but they can have unpleasant side effects and put the patient at risk of infections, cancer, strokes and heart attacks.

Finding a way to prevent patients needing lifelong immunosuppressant treatment is the "Holy Grail" of transplant medicine, experts say.

These doctors are trying to 'con' the immune system

Dr Anthony Warrens
In the past, patients did not survive after transplants for longer than a decade.

But as patients live for longer, avoiding the side effects that come with the drugs becomes ever more important.

Some patients are able to accept donor organs without immunosuppresants - but doctors do not know why.

Educating the immune system

Research presented to the International Congress of The Transplantation Society in Miami, Florida, showed how some patients' immune systems can be fooled into believing they do not need anti-rejection drugs.

In a study from India, kidney transplant patients had crushed donor kidney tissue injected into their thymus - the body's "immune engine room" where cells can be "educated".

Twenty-six patients at the Institute of Kidney Diseases and Research Center at Civil Hospital Campus in Ahmedabad, India were given the injection 19 days before their transplant.

It was hoped that time would allow the developing T cells in the thymus to be "introduced" to the donor tissue, so that when they were circulating around the body they would not attack the donor organ.

Ten days before the transplants, the patients were also given an injection of stem cells from their donor's bone marrow into their own bone marrow and blood stream.

Three months after their transplant, the patients were weaned off the anti-rejection drug cyclosporine.

So far, it has been just four months since the first patient stopped taking the drug.

Previous work involving 43 kidney transplant patients given stem cells from the donor's bone marrow into their blood stream, bone marrow, liver and thymus.

Thirty-two have already been weaned off cyclosporine one year after transplant, and the rest will also stop taking the drugs once they have reached the anniversary of their operation.

Patients who had a kidney transplant without any kind of pre-operative treatment were not able to be weaned of the anti-rejection drug.

One-off dose

In a separate study, researchers from the University of Pittsburgh treated 12 patients with just one anti-rejection pill instead of the usual two or three.

Nine have not rejected their organs.

Further research from Pittsburgh involved giving 150 patients a one-off dose of a drug which depletes important immune system cells hours before the transplant operation, then lower than usual doses of one anti-rejection drug from one day afterwards.

If there is no rejection 90 days after the transplant, the patient is weaned off completely.

Researchers said similar experience from transplants carried out 40 years ago proved transplant patients could survive without anti-rejection drugs.

Seven people have been living without anti-rejection drugs for between two-and-a-half and 38 years.

Dr Anthony Warrens, a specialist in renal medicine and immunology at London's Hammersmith Hospital and spokesman for the National Kidney Research Fund, told BBC News Online: "These doctors are trying to con the immune system that the donor organ is part of oneself.

"This happens naturally in a small number of people, but we don't know why.

"We are trying to identify the natural process that allows tolerance, without stem cells or thymus injections."

Dr Warrens added it was hard to test out the natural acceptance theory because transplant patients did not want to test whether they could manage without the anti-rejection drugs because they do not want to risk their transplant.

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