After a transplant surgery,
anti-rejection drugs for the organ recipient are a must, but with prolonged
use can have serious side effects, including infections, heart disease and
cancer. A team led by Joshua Miller, MD, a researcher at Northwestern
University’s Feinberg School of Medicine, is working with Northwestern
Memorial Hospital’s department of organ transplantation to enroll
qualifying subjects in a new research study that seeks to transplant stem
cells from a kidney donor’s bone marrow into the recipient, with the hope
of gradually eliminating the need for anti-rejection drugs. If research
proves successful, it would mean a dramatic change in the post-transplant
quality of life for the transplant recipient.

Northwestern is the only center in Chicago and one of four centers
nationally looking at this topic. The Feinberg School of Medicine has
received a four-year, $2.5 million grant from the National Institutes of
Health to enroll 20 patients in the study, which is called “Donor Stem
Cells, Campath, T/B Cell Regulation In HLA-Identical Renal Transplants.”

The first subjects to participate in the study underwent kidney
transplant surgery on Thursday, Jan. 10. Sharon Flood of Pingree Grove,
Ill. donated her kidney to her brother Steven Yelk of Gurnee, Ill., who
suffers from polycystic kidney disease (PKD), which causes cysts filled
with fluid to form throughout the kidneys. Eventually, these cysts take
over the healthy kidney tissue and the kidneys fail. “Our family is very
close and there are seven brothers and sisters. I was thrilled to learn
that I was a match and would be able to help Steven,” Sharon commented
before the surgery.

Joseph Leventhal, MD, PhD, transplant surgeon, associate professor of
surgery and director of the Living Donor Renal Transplant Program at
Northwestern University’s Feinberg School of Medicine, preformed the kidney
donor’s surgery and Michael Abecassis, MD, MBA, chief of the division of
transplantation, and dean of clinical affairs for Northwestern University’s
Feinberg School of Medicine, performed the recipient’s surgery.

“The surgery was successful, everything went according to plan and the
new kidney is functioning well,” said Dr. Abecassis. From here, the kidney
recipient will begin the experimental portion of the study.

This study is open to HLA-identical sibling kidney donor and recipient
pairs. HLA, or human leukocyte antigen, is one of a group of proteins found
on the surface of white blood cells and other cells that play an important
part in the body’s immune response to foreign substances. These antigens
vary from person to person, and an HLA compatibility test is performed
before organ transplantation to find out if tissues match between a donor
and a recipient.

The study is limited to only HLA-identical sibling pairs because these
siblings genetically have a more similar set of immunologic markers than a
non-related HLA-identical pair. Because this population has the closest
genetic relationship, they have the best chance for success with the study.
Overall, HLA-identical siblings have very low rejection rates for kidney
transplants but until now have still required immunosuppressive drugs to be
taken for life.

How does it work?

Stem cells are formed at the marrow and are common blood cells from
which other specialized blood cells, like immune cells, develop. These stem
cells are considered important to help prevent rejection of the kidney
transplant. By transplanting these cells from the kidney donor into the
recipient, the study seeks to prove that the stem cells will mature in the
recipient’s body and will allow his immune system to accept the new organ
as his own.

For the kidney donor, the laparoscopic surgery occurs in the standard
manner. After the kidney is removed, bone marrow is drawn from the donor’s
hip bone. About three months following the surgery, the donor undergoes two
procedures called leukopheresis, happening one day apart, where stem cells
mobilized from the marrow are collected so that they can be given to the
kidney recipient to help his body acclimate to the transplant.

Approximately one month before the transplant surgery, the recipient
undergoes leukopheresis to draw white blood cells which are stored in a lab
for later testing. After transplant surgery, the recipient receives four
separate inf

The stem cells are infused into the transplant recipient via an IV in a
procedure that lasts about 15 minutes. The first infusion is five days
after surgery, the next is about three months after surgery, then six
months and finally nine months after the transplant. During this time the
recipient is treated with Campath-1H, a potent antibody used extensively at
Northwestern to prevent rejection, in addition to the other standard
anti-rejection medications. About a year after the surgery, the subject is
weaned off of one anti-rejection drug, then another. There are also ongoing
tests to ensure the recipient is tolerating the kidney.

“This is an exciting area of research which holds a great deal of
promise if successful,” says Dr. Abecassis. “We are excited to be the only
center in the region offering this to qualifying patients.”

About Northwestern Memorial Hospital

Northwestern Memorial Hospital is one of the country’s premier academic
medical centers and is the primary teaching hospital of the Northwestern
University Feinberg School of Medicine. Northwestern Memorial and its
Prentice Women’s Hospital and Stone Institute of Psychiatry have 897 beds
along with 1,424 affiliated physicians and 6,464 employees. Northwestern
Memorial is recognized for providing state-of-the-art patient care and
exemplary clinical and surgical advancements in the areas of cardiothoracic
and vascular care, gastroenterology, neurology and neurosurgery, oncology,
organ and bone marrow transplantation, and women’s health.

Northwestern Memorial received the prestigious 2005 National Quality
Health Care Award and is listed in eight specialties in U.S. News & World
Report’s 2007 rankings for “America’s Best Hospitals.” For seven years
running, Northwestern Memorial has been rated among the nation’s “100 Best
Companies for Working Mothers” by Working Mother magazine and has been
chosen by Chicagoans for more than a decade as their “most preferred
hospital” according to the National Research Corporation’s annual survey.
Northwestern Memorial carries the Magnet status designation in nursing, the
highest recognition possible for patient care and nursing excellence.

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