New hope for transplants

Research: UM doctors work to make donor kidneys last longer, trying to reduce the need for second, third -- even sixth -- organs.

February 05, 2002|By Jonathan Bor | Jonathan Bor,SUN STAFF

When Steven Boose learned his blurred vision and headaches were signs of advancing kidney disease, he counted on a transplant to save his life and spare him the ordeal of regular dialysis treatments.

The Westminster resident got his kidney, but it didn't last long. Neither did the next kidney, the one after that, or the two that followed. In the past 24 years, Boose has received five transplanted kidneys. He is awaiting his sixth.

Although Boose, a former high school teacher who once could lift twice his weight and run a mile in less than five minutes, considers himself lucky to be alive, he never thought that getting a transplant - and waiting for another - would become a way of life.

"Thank God I'm here," he said in a recent interview, resting on a cot while his blood trickled through the cylindrical filter of a dialysis machine. "But this has been something of a disaster. I had no idea that I'd have all these complications."

More than two decades after drugs revolutionized the field of organ transplantation - taming the body's tendency to reject foreign material - doctors are turning their attention to making the organs last longer.

Dr. Stephen T. Bartlett, chief of the transplant service at the University of Maryland Medical Center, said few patients have received as many kidneys as Boose but that many share his underlying problem.

Low-level rejection

Although medications have done an excellent job preventing the rejection that once doomed organs in the months and years after surgery, they are frequently unable to prevent a low-level rejection that can wear down an organ and eventually cause it to fail.

Added to that is the bitter irony that the drugs themselves can leave the kidneys scarred and unable to function - a toxic effect that is sometimes indistinguishable from the rejection that medications are meant to prevent.

"It's frustrating to see somebody go through the surgery and recover, and then to realize that, in some cases, there is an inevitability that the kidney will eventually fail," Bartlett said.

Although only about a tenth of the 12,000 patients who receive transplanted kidneys each year are repeat customers, Bartlett said, about a third of the 50,000 people on the national waiting list have had at least one transplant.

Armed with a federal grant that could bring $16 million over five years to the medical school, Bartlett hopes to find a way to trick the body into accepting the organ with little or no medication. The technique, he said, might involve dosing the patients with heavy medications up front, then weaning them off all but the least toxic one.

Doctors collaborating in the research at the National Naval Medical Center in Bethesda and the National Institutes of Health are due to receive an equal amount - bringing the total funding to $32 million.

Anti-rejection drugs work by suppressing the immune system, the body's mechanism for attacking foreign bodies. Doctors usually prescribe three drugs, a tactic that enables them to keep doses of each drug low and, with luck, minimize their toxic effects.

The drugs have markedly improved the long-term survival of transplanted kidneys. Doctors project that half of kidneys transplanted from cadavers will last 13 years or more. Kidneys from living donors do better, with half expected to last at least 21 years.

The majority of patients, however, don't have living donors. So, barring medical advances, most who undergo a transplant while young will need at least one additional kidney during their lives.

Boose has suffered more than most.

Although born with a hereditary kidney problem, Boose lived without symptoms until his late 20s, when blood tests showed that his kidneys were failing. He began dialysis treatments and signed up for a new kidney - waiting only seven months before getting his transplant at Johns Hopkins Hospital.

His body soon rejected the organ, so Boose went back on the waiting list and back on dialysis.

Four subsequent transplants would last varying lengths of time - from a few weeks to 4 1/2 years - with each failure requiring long stretches on dialysis and frustrating months and years waiting for a new organ.

His operations were performed at Hopkins, the University of Minnesota and the University of Pittsburgh. Now, he is trying his luck at the University of Maryland Medical Center, which transplants more kidneys than any hospital in the United States.

Bartlett, who will become his surgeon if an organ becomes available, says Boose's medical history suggests that his organs succumbed to the combined strains of rejection and drug toxicity.

One of the drugs, the steroid prednisone, is most likely responsible for another problem - the widespread mineral loss that has weakened his bones and joints.

"I've had six hip replacements and neck surgery," said Boose, a wiry man with shaggy, light brown hair and a craggy smile. "I had my right shoulder replaced nine or 10 months ago, and my left shoulder needs it now."

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