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Entries in Transplants (6)

Thursday
Apr262012

One Kidney, Three Bodies: After Failed Transplant, Kidney Gives New Life 

Keith Brofsky/Thinkstock(CHICAGO) -- In a medical first, a transplanted kidney rejected by one patient was successfully transplanted into another patient, according to doctors at Northwestern Memorial Hospital in Chicago.

Twelve years ago, Ray Fearing, 27, of Arlington Heights, Ill., was diagnosed with focal segmental glomerulosclerosis (FSGS), a rare disease characterized by the buildup of scar tissue on the kidney. Most often found in young adults, the disease prevents harmful chemicals in the blood from filtering through the kidney.

When his disease worsened in April 2011, he was placed on the kidney transplant waiting list. His wait would not be long, just two months, after his younger sister, Cera, 21, stepped up right away to try to save her big brother.

"Before I even asked her she was ready to volunteer" her kidney, Ray Fearing said.

"It was very exciting," he said. "I'd been looking forward to it for a long time."

During routine kidney transplants, the new organ that is placed in the recipient rarely shows signs of recurring disease. But in patients with FSGS, there is a 50-percent chance that the transplanted kidney will also develop the disease.

Fearing was on the wrong side of those odds. Within two weeks of the transplant, surgeons removed his new kidney.

"I was making all these plans for the future because I would have a new kidney," said Fearing. "I was distraught and very wounded by the whole experience."

But instead of discarding the kidney -- which is routine in the event of a failed transplant -- Northwestern Memorial Hospital surgeons, with Cera Fearing's consent, decided to give the kidney another chance.

For the first time, doctors successfully re-implanted the so-called damaged kidney in another patient. Once the kidney was removed from Ray Fearing, it began to show signs of recovery from damage caused by its short-lived exposure to FSGS.

Within a few weeks, the kidney restored itself and was fully functioning in the new recipient, 67-year-old surgeon and father of five, Erwin Gomez.

"We proved for the first time that the disease is reversible in an organ once it's taken out of the body," said Dr. Lorenzo Collon, a transplant nephrologist and medical director of the kidney transplant program Northwestern Memorial Hospital in Chicago.

This procedure challenges the idea that surgeons can only attempt to transplant an organ once, said Collon, whose findings were published in the New England Journal of Medicine.

"Instead of removing the organ and throwing it away, if you have a good surgical background to reconstruct the vessels, you can put the kidney in someone else and it can work," said Collon.

More than 92,000 Americans are on the waiting list for a kidney transplant, and nearly 3,000 new patients are added to the list each month, according to the National Kidney Foundation. In 2011, nearly 17,000 Americans underwent a kidney transplant.

Although transplants take place when a match is found between a donor and recipient, in some cases -- as in Fearing's -- there's still a chance the transplant may not be successful, Collon said. But recycling the transplanted kidney will give more recipients a shot within an already-limited donor pool, he said.

"It will increase the donor pool, which needs to be increased anyhow," said Collon.

Fearing was put back on dialysis and will have to wait at least a year before another transplant attempt can be made.

"I'm excited to be a part of this, even though it didn't work for me," said Fearing.

The road ahead for Fearing is complicated by the fact that the chance of his disease damaging another new kidney is even higher than 50 percent, Still, Fearing says he remains optimistic.

"I'm convinced that I should be hopeful," he said.

Copyright 2012 ABC News Radio

Thursday
Mar152012

16-Year-Old’s Death Becomes a Life-Changing Gift

Jupiterimages/Thinkstock(PLATTE, S.D.) -- Andrea Cleveland was leaving her boyfriend’s home just south of Platte, S.D., last November when her car hit loose gravel and rolled.

She died from the injuries she sustained in the crash.

Just 16, Andrea was a new driver who had decided to become an organ donor when she got her driver’s license. Her decision likely saved the lives of several others.

This week, 2 1/2-year-old Keegan Johnson of Fridley, Minn., and 30-year-old Meleah Richter, of Northfield, Minn., met Andrea’s family. Keegan was the recipient of Andrea’s liver; Richter received her lungs. Andrea also donated her pancreas, kidneys, eyes, heart valves and other tissues.

“Of course you can tell that she was a very caring person by her being a donator,” said her mother, Marlene Cleveland, in an interview with ABC Minneapolis affiliate KSTP. “It was her idea, it was her choice.”

It was only after Andrea was declared brain dead, and hospital personnel noted that the teen’s license indicated that she was an organ donor, that her parents learned of their daughter’s special generosity.

Andrea’s friends told her parents she was proud of her decision.

“She came to school first thing, and was like ‘I got my driver’s license,’ and ‘I’m a donor, I’m a donor,’” friends told her father, Jeff Cleveland. ” She made a big deal out of it that she was a donor.”

In Richter’s eyes, Andrea lives on, “She didn’t deserve to go but she’s an angel now, she’s my angel, she’s Keegan’s angel, she’s everybody’s.”

Copyright 2012 ABC News Radio

Monday
Feb272012

Turkish Doctors Almost Succeed in First-Ever Four-Limb Transplant

Keith Brofsky/Thinkstock(ANKARA, Turkey) -- Sevket Cavdar, 27, was almost the first person in the world to undergo a successful transplant of two arms and two legs at Hacettepe University Hospital in Ankara, Turkey, on Friday.

But hopes were dashed on Monday when doctors had to amputate all four of the transplanted limbs because of  “metabolic complications,” according to a statement from the hospital.

The hospital said Cavdar was currently in the hospital’s intensive care unit but offered no further details about his condition, according to a report from Agence France-Presse.

Cavdar lost all four of his limbs in 1998 after he was accidentally electrocuted.

The hospital announced on Saturday that the 20-hour operation by a team of 52 doctors had succeeded, and Dr. Murat Tuncer, the lead surgeon, called for blood donations to avoid possible complications after the surgery.  Then, doctors had to remove one leg when Cavdar’s heart and vascular system failed to sustain it.  The amputation of the other limbs followed shortly thereafter.

Dr. L. Scott Levin, president of the American Society of Reconstructive Transplantation, told ABC News that it’s likely that Cavdar went into shock after the attached limbs were deprived of adequate blood supply and began releasing metabolites in his body that damaged his circulation.

“In these cases, it’s life before limb.  You have to amputate the limbs to save the patient’s life,” said Levin, who was not involved in the Turkish operation.

Levin explained that limb transplantation was an exceedingly complicated process that required precise coordination, careful rehearsals and contingency plans for things that could go wrong.  When he and a team at the Hospital of the University of Pennsylvania performed a transplant of two hands in 2011, it took almost 20 doctors and two years of planning to ensure the success of the operation.

Limb transplantations are not only difficult for doctors to plan but extremely taxing for patients.  Levin said the attempt to give Cavdar four new limbs was particularly bold.

“In these transplants, there may be a threshold that we cross in terms of how much of a burden we put on a patient when we try to do more than one limb at a time,” Levin said.  “Perhaps the limit is two extremities and perhaps not more.”

Copyright 2012 ABC News Radio

Wednesday
Oct122011

US Cord Blood Supply Lacking, GAO Says

ABC News Radio(WASHINGTON) -- The national supply of umbilical cord blood is not growing as fast as it could, in part because of competition from private blood banks and a slowdown in growth in the cord blood market, according to a new report from the Government Accountability Office (GAO).

In the year after the government created a National Cord Blood Inventory (NCBI) in 2005, sales of cord blood rose by nearly 14 percent, then went up more than 38 percent the following year.

But sales grew just 0.4 percent between 2009 and 2010.

In addition, public cord blood banks are facing competition from the growing number of private banks, the GAO report said. Some parents choose to bank their infants' cord blood with a private blood bank so it can be used by a family member if needed, an option not available if they donate to a public cord blood bank.

Although the overall number of umbilical cord blood units available for transplants has grown, more progress is needed, the report writers concluded.

There are nearly 135,000 units of cord blood available in the NCBI, and in 2010 about 1,200 patients received cord blood transplants from units identified in the registry.

Still, the government and cord blood advocates would like to see 30 percent more cord blood units and say there aren't enough units from certain racial and ethnic groups, who may have difficulty finding a match if they need a stem cell transplant.

A 2005 stem cell law provided funding to bank 150,000 new units of cord blood. At the time, there were an estimated 44,000 units, which was considered inadequate to offer a wide range of units for those who might benefit from a stem cell transplant.

As mandated by the law, the federal government contracted with 13 public cord blood banks to provide blood. Because the donor in a cord blood transplant doesn't need to be an exact match, cord blood is particularly valuable for people for whom an exact donor match can't be found, including African Americans and people of mixed ethnic heritage with blood and genetic disorders who often have a difficult time finding a transplant donor.

When the stem cell law was reauthorized in 2010, it included new money to increase the genetic diversity of the supply. More than 70 percent of the units of cord blood in the NCBI are from white and Hispanic donors. Just 14 percent of all units in the registry are from blacks, and just 4 percent are from Asians.

Thousands of people who need a transplant every year can't find a match, said Machi Scaradavou, MD, pediatric oncologist at Memorial Sloan-Kettering Cancer Center in New York City and medical director of the New York Blood Center's National Blood Cord Program.

The federal government pays the 13 cord blood banks -- most of which are nonprofits -- a little more than $1,000 for each unit banked, but the banks' biggest source of income is from selling the unit to be used in a transplant. The GAO report said banks receive payments of between $22,800 and $30,000 per cord blood unit.

But demand for cord blood seems to be slowing, and along with it, money from the blood banks' biggest revenue stream.

HHS added that the waning demand is likely due to the costs associated with cord blood transplants and issues with banking and not that fewer people need transplants.

The GAO claims that part of the demand slowdown may center around the medical community's questions about which diseases can most benefit from stem cell transplants. HHS has convened an expert panel to develop a consensus for which diagnoses stem cell transplants would be an accepted standard of care.

Another option to improve blood cord collection identified in the report is establishment of a remote collection program that would allow mothers who deliver a child at a site that is not equipped to collect the cord blood to send the umbilical cord to a bank that can process it.

To examine that idea, the Health Resources and Services Administration is trying out remote collection to determine whether using a "cord blood donation kit" can increase donations.

Of the 758 units collected through the remote collection pilot program as of March 2011, just 68 were banked. Most units were considered unusable because they arrived too late, not enough cord blood was collected, or required labels or documents were missing.

Officials who were interviewed for the GAO report said they weren't sure samples sent via a kit would meet the FDA's requirement for licensure, which goes into effect Oct. 20.

The FDA regulates cord blood used in transplants when the donor is not related to the patient. Starting in less than 10 days, centers that collect cord blood units must be licensed by the FDA and the units will be treated like any other FDA-regulated biological material.

Units from nonlicensed centers may still be used in FDA-approved clinical trials.

A number of banks expressed concern over the new FDA regulations, including the cost of complying.

Copyright 2011 ABC News Radio

Thursday
Oct062011

Experimental Protocol May Eliminate Need for Immunosuppressants

Owen Franken/Getty Images(STANFORD, Calif.) -- One of the biggest complications associated with organ transplants is the need for lifelong use of immunosuppressants to prevent rejection, which typically cause a number of serious side effects.

But a recently developed post-kidney transplant regimen developed by doctors at the Stanford University School of Medicine could make it possible for patients to live without the need for immunosuppressive drugs.

Eight of 12 patients given the new post-transplant protocol, which consisted of radiation and donor stem cells, were able to be weaned off immunosuppressants after about six months and were able to stay off them for at least one year and, in some cases, three years.

"The majority of patients were able to discontinue antirejection medications, and all patients had excellent graft function at the last observation point," the authors wrote.

In a short letter published in the New England Journal of Medicine, the doctors described the protocol, called "induced immune tolerance," in the kidney transplant patients.

After their transplants, the patients received small doses of radiation as well as stem cells from their donors with the hope that these donor cells would mix with their own cells and be recognized by the body as their own.

So far, the patients have done well.

Transplant surgeons not involved in the Stanford research say the new therapy is very promising since a lifetime of anti-rejection medicines can involve serious complications.

"It would be great if we could do something up front and just stop the immunosuppressants," said Dr. Jonathan Bromberg, chief of the division of transplantation at the University of Maryland Medical Center in Baltimore. "They can hurt the kidneys, can cause weight gain, high blood pressure, diabetes, make people more susceptible to infections and because they can cause high blood pressure and diabetes, they can increase susceptibility to cardiovascular disease."

Some transplant patients can live without immunosuppressive drugs, but it's not yet clear why.

"Some people have their own tolerance to the transplanted organ that develops, but we're not sure why that develops in some people and not others," said Dr. Michael Porayko, medical director of liver transplantation at Vanderbilt University Medical Center in Nashville.

While being able to avoid the harmful effects of immunosuppressants is a huge benefit of this new regimen, there are also potential drawbacks.

"The downside is you have to irradiate people. You could have problems later on because radiation in its own right can cause problems," said Dr. Lewis Teperman, chief of transplant surgery at NYU Langone Medical Center in New York.

Dr. George Burke, professor and director of Lillian Jean Kaplan Renal Transplantation Center at the University of Miami's Miller School of Medicine, said he's cautiously optimistic about the research. He believes future studies should address, among other things, the role of other types of immune cells called memory T cells.

Copyright 2011 ABC News Radio

Friday
Jun102011

Charla Nash Gets Face Transplant After Chimp Attack

Jupiterimages/Thinkstock(NEW YORK) -- A team of more than 30 doctors and nurses have carried out a face transplant for Charla Nash, the Connecticut woman who was mauled by her friend's pet chimpanzee in 2009. An attempt to give her a pair of new hands failed, and the transplanted hands were removed.

Nash, 57, was helping Sandra Herold lure her pet chimp Travis inside when the 200 pound animal ripped off her nose, lips, eyelids, and hands before being shot and killed by police.

Since the attack, Nash wore a straw hat with a veil to cover her injuries, but revealed her mangled face on a November 2009 episode of Oprah.

The date of the transplant will not be released to protect the donor's identity, but officials at Brigham and Women's Hospital said it occurred in late May. The 20-hour surgery was fraught with complications, according to John Orr, a spokesman for the Nash family.

Nash is the third person to undergo a face transplant at Brigham and Women's Hospital. Dallas Wiens received the nation's first face transplant patient there in March.

The only other known simultaneous face and hands transplant was performed in France in 2009, and that patient later died.

Herold's 911 call offered a haunting description of the violent attack. Herold can be heard screaming that the ape had killed her friend and was "eating her."

"The chimp killed my friend," Herold screamed. "Send the police with a gun. With a gun!"

The dispatcher later asks, "Who's killing your friend?"

"My chimpanzee," she cries. "He ripped her apart! Shoot him, shoot him!"

Copyright 2011 ABC News Radio







ABC News Radio