Physicians Transplant Kidneys into Children Without Immune Suppressing Drugs

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  • Physicians have performedkidney transplants on children without using immune-suppressing drugs.
  • In these cases, a parent donated both bone marrow stem cells and a kidney to their child.
  • Two of the three children are siblings, where one parent was able to donate to one child and the other parent to the sibling.

​Three pediatric patients with a rare genetic disease that causes kidney failure have successfully been treated with transplanted kidneys without using anti-rejection drugs or treatments.

Experts at Stanford University treated three children with a rare condition called Schimke immuno-osseous dysplasia (SIOD). This genetic condition not only causes a weakened immune system but also causes kidney disease, according to the Genetic and Rare Diseases Information Center at the NIH.

In all three cases, a parent donated both bone marrow stem cells and a kidney to their child. Two of the three patients are siblings, where one parent was able to donate to one child and the other parent to the sibling.

According to a report published in The New England Journal of Medicine, none of the children who have undergone this procedure have had any major or life-threatening complications and still do not need anti-rejection medications.

“Safely freeing patients from lifelong immunosuppression after a kidney transplant is possible,” said Dr. Alice Bertaina, associate professor of pediatrics at the Stanford University Lucile Packard Children’s Hospital, in a press release.

A medical breakthrough

The biggest challenge with organ transplantation is controlling the response of the donated organ and the recipient’s immune system as they try to adapt to each other. However, when the transplanted organ does not adapt well, it attacks the body in a phenomenon called graft verse host disease (GvHD).

For most organ transplants, physicians complete a battery of tests and matching techniques to ensure a donated organ won’t be rejected by a host body. Immune-suppressing medications reduce the chance that the recipient’s immune system does not view the donated organ as a threat and fight it.

“The problem with transplantation is dealing with the body’s immune system as the body has cells that attack in transplantation,” Dr. Amit Tevar, Associate Professor of Surgery and Director of the Kidney and Transplant Program at the Starzl Transplant Institute at the University of Pittsburgh Medical Center. “We currently have to find balance of with how much medication to give to control that response, but this research mitigates that need.”

Dual transplant can help people avoid immune-suppressing drugs

The scientists used a technique called “dual immune/solid organ transplant,” which allows for patients to receive both stem cells and a solid organ from a donor.

By transplanting stem cells, scientists can replace the immune system of the patient, making it compatible with the organ that will be donated. Although this transplantation protocol is not new, the success of its use is considered a breakthrough.

The scientists at Stanford adapted to a less toxic method by removing one of the cell lines which cause GvHD. With this cell line removed, stem cells from the donor are then given to the recipient, and after about 60 to 90 days, the immune system is completely functional.

“This technique has been attempted several times in the past, but this is the first time it really has been successful,” Tevar told Healthline.

Tevar said this new research is a “medical breakthrough.”

“First, we have never seen this in children and secondly, without the use of anti-rejections medications, these kidneys will be more durable over the years, which is promising for the future,” Tevar told Healthline.

How this could help others

There are currently over 106,000 people waiting for organs throughout the United States. According to the Organ Procurement Transplantation Network, an overwhelming majority, almost 90,000, are waiting for a kidney transplant.

Getting a kidney or new organ is a renewed chance at life for patients, so breakthrough methods like this truly impact people’s lifestyle and longevity.

Traditionally, people who receive organ transplants must be on anti-rejection or immunosuppressive medications for the rest of their lives. This helps in preventing the transplanted organ from attacking the body of the recipient through GvHD.

While taking a pill daily may seem like a small price to pay for a new kidney, these medications also have side effects such as high blood pressure, an increased risk for cancer, and lowering the immune system, which can lead to severe infections and hospitalizations.

This breakthrough method has provided the children with a better chance of avoiding dialysis and living a relatively normal life.

“They are doing everything: they go to school, they go vacation, they are doing sports,” Bertaina said in a press release of the children. “They are having completely normal lives.”

These young scientific pioneers and patients may have also helped pave the way for future research and patients to receive transplants without immunosuppressive drugs.

According to the Stanford press release, the team is now using the same protocol on other patients with underlying conditions, particularly children who have had a kidney transplant that ended up being rejected by their bodies.

“That’s a challenge, but it’s not impossible,” says Bertaina. “We’ll need three to five years of research to get that working well.”

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