Tackling challenge of organ rejection

In the solid organ transplant world, organ rejection is one of the biggest challenges. To prevent rejection, patients must remain on antirejection drugs for the rest of their lives.

“It’s the Achilles heel of solid organ transplants,” said Clifford Miles, MD, UNMC associate professor and Nebraska Medicine nephrologist and
medical director of Kidney & Pancreas Transplantation. “Antirejection drugs protect the organ from rejection, but they also open the patient to long-term side effects like weight gain, high blood pressure and diabetes.”

Medical center kidney transplant and blood and bone marrow stem cell transplant teams are collaborating in a phase 3 clinical trial to overcome this obstacle by transplanting a living kidney donor’s stem cells into the recipient shortly after the kidney is transplanted.

“We were hand-picked to participate in this multicenter trial that involves about 15 elite medical centers across the country,” Dr. Miles said. “We’re ideal for this trial because we have very strong programs in both of these areas.

“The outcome for living kidney transplants is very good, but this has the potential to make these types of transplants even more successful,” he says. “A kidney from a living donor has an average life of 15 to 20 years compared to 10 to 12 years for a deceased-donor kidney. Some transplant recipients will need three or even four transplants in their lifetime. Our hope is to make these kidneys last their entire lifetime with little or no complications.”

If successful, it will also free up more kidneys for others.

One in five kidney transplant candidates on the list are waiting for a second or third kidney, Dr. Miles said. More than 93,000 people are on the kidney transplant waiting list.

One of the risks of the trial is the potential for graft-versus-host disease, a condition in which the donated bone marrow or peripheral blood stem cells recognize the recipient’s body as foreign and attack the body. It’s sometimes a complication with cancer patients undergoing blood and bone marrow stem cell transplants.

To minimize this complication in this trial, the donor’s stem cells are sent to a lab where the cells undergo cell manipulation to remove the part of the cells responsible for initiating this rejection, says Zaid Al-Kadhimi, MD, UNMC associate professor of internal medicine, Nebraska Medicine nephrologist and director of the bone marrow transplant and cellular therapy program.

“Our team will then be able to use our experience and expertise in this area to monitor and manage this potential issue. The results for this trial could be life-changing for these patients,” Dr. Al-Kadhimi said. “It’s the potential for a better quality of life and never needing a transplant again.”

Institutional Research Board study protocol number 066-20.