For patients who have had an organ transplanted, taking immunosuppressive medications is a necessary evil. They need to take drugs every day for the rest of their lives, and some of these drugs can bring with them considerable side effects. Transplant patients therefore often suffer from increased rates of infections and tumours over the long term, diabetes, high blood pressure and, despite taking the medicines, the transplanted organs can still be gradually rejected. “Not needing these accompanying medicines any more would improve patients’ quality of life massively,” reports transplant immunologist Thomas Wekerle from the MedUni Vienna.
The fact that this could one day become reality has been illustrated by the sensational case of a young patient who, after bone marrow and subsequent renal transplant, is able to completely forego immunosuppressive medications. This patient had a tumour and was given a bone marrow transplant at the St. Anna Children’s Hospital. Years later, renal failure necessitated organ transplantation at the Vienna General Hospital. What was remarkable was that both the bone marrow and the donated kidney came from the same donor. The previous transplantation of the bone marrow from the same donor meant that the patient was immunologically tolerant of the new kidney. Because this meant that there was no danger of rejection, all of the patient’s immunosuppressive medications could be stopped. The patient has since been free of complaints and no longer requires any immunosuppressive drugs.
Tolerance of donated organs without suppressing the body's own immune defences
Research teams at the MedUni Vienna are pursuing this path of tolerance induction and have reported a number of initial successes. Says Thomas Wekerle on these trials: “Our aim is to transplant bone marrow without the recipient needing to have the massive treatment prior to it required when transplanting bone marrow to treat a tumour, which is what happened with the patient described in the St. Anna case. Only then would this approach be useful in clinical practice for organ transplantation.” Current research results show that this type of non-toxic bone marrow transplantation is actually fundamentally possible. Primary author Nina Pilat found that the combination of bone marrow transplant with the administration of the body’s own regulatory T cells (lymphocytes, “white blood cells”) actually leads to better tolerance results than with the usual preceding irradiation of the body. These advances bring the long-term goal of medication-free transplants another step closer.
MedUni Vienna and Vienna General Hospital an example of interdisciplinary collaboration
Treatment of this complexity is only possible at institutions of excellence such as the MedUni Vienna / Vienna General Hospital. In the case described, a wide, multi-disciplinary team was involved. In addition to the treatment at the St. Anna Children’s Hospital, the specialty fields of surgery, haematology, nephrology, blood group serology, pathology and transplant immunology also had a part to play.
Transplant Forum Symposium 2014 on 2 April
The MedUni Vienna’s Transplant Forum Symposium recognises the importance of interdisciplinary collaboration in the field of stem cell and organ transplantation (www.meduniwien.ac.at/transplantforum). The event will be held on 2nd April in the Jugendstilhörsaal at the MedUni Vienna (1 p.m. to 4:15 p.m.). Address: Spitalgasse 23, 1090 Vienna. Five research clusters at the MedUni Vienna The project falls within the remit of the Immunology research cluster. There are five research clusters at the MedUni Vienna in total. The MedUni Vienna is increasingly focusing on fundamental and clinical research in these areas. The other four research clusters are Cancer Research / Oncology, Cardiovascular Medicine, Medical Imaging and Medical Neurosciences.AAA Service: The Journal of Heart and Lung TransplantationAAA “T-regulatory cell treatment prevents chronic rejection of heart allografts in a murine mixed chimerism model.” Nina Pilat, PhD, Andreas M. Farkas, MSc, Benedikt Mahr, MSc, Christoph Schwarz, MD, Lukas Unger, Karin Hock, PhD, Rupert Oberhuber, MD, Klaus Aumayr, MD, Fritz Wrba, MD, Thomas Wekerle, MD. The Journal of Heart and Lung Transplantation, Vol 33, No 4, April 2014.