21st century advances in transplant surgery? – ABC Online


MARK COLVIN: Until the mid ’60s, if you had severe kidney disease you were almost certain to die pretty soon.

Then came the new procedure of transplantation, and as a result thousands of people went on to be able to live reasonably normal lives for years and even decades.

As some listeners may know, I joined their ranks when I received a kidney in 2013.

So I know personally that the price you pay for transplantation is a lifetime of taking immune-suppressant drugs.

Could that ever change?

Australian kidney surgeon, Professor Sir Peter Morris, is emeritus Nuffield professor of surgery at the University of Oxford, former president of the Royal College of Surgeons of England, and founder of the Oxford Transplant Centre.

He gave a lecture today at Sydney’s Prince of Wales Hospital on transplantation as a 20th century miracle.

I asked him if the 21st century could expect more miracles to come.

PETER MORRIS: We may achieve in this century the holy grail of transplantation which is the phenomenon of tolerance, which means that a patient would get a kidney from a deceased donor or a relative and with various manipulations would not require immune-suppressant drugs for the rest of their lives, and there’d be no rejection.

Now that’s been the holy grail of transplantation and transplantation biologists for years and years and years but it is achievable but it’s not just round the corner but it’s getting closer.

MARK COLVIN: You said you hoped to see it this century. That, I suppose implies that there have been, perhaps, baby steps towards it in the last few years?

PETER MORRIS: Oh, absolutely, and there are patients who are tolerant by accident. In other words they’ve stopped their drugs, immune-suppressant drugs, not told their doctors, and although the usual outcome is rejection when you do that, there’s a small number, there are about 22 kidney transplant recipients now been identified who’ve stopped their drugs and been off them for several years and have not rejected the kidney.

MARK COLVIN: That’s extraordinary.

PETER MORRIS: And those patients are being studied intensely as you might imagine.

MARK COLVIN: A bit like those AIDS patients who are resistant, or rather people who’ve been infected with HIV but are resistant to it. It’s that sort of thing where you’ve got a tiny number and they become your key study population.

PETER MORRIS: Yeah.

MARK COLVIN: So what is being learned about this intensively studied group?

PETER MORRIS: Well, they do seem both in the USA and Europe to have parts of a molecular signature that are in common, particularly as related to a lymphocytes subpopulation called b-lymphocytes.

Now what that means, no one knows, but it’s interesting that there’s something in common in these patients that has not been identified before. Now whether that helps you to induce tolerance deliberately is another matter.

The other important development is the recognition that in experimental models, animal transplants where tolerance has been induced, one thing in common is that it mostly the tolerance is maintained by a subpopulation of lymphocytes called T regulatory lymphocytes, or T-regs.

And now, in fact, there’s a big study in Europe, multi-centre study also involving the USA where these T-reg cells are being grown up from the recipient and then cultured to enlarge them and then after the transplant are being injected into the patient on say day 5 day 10 with the hope of producing tolerance but also with the hope of seeing – it’ll be very gradual – can you reduce their immune-suppressants slowly and perhaps eventually stop it.

Immuno-suppressant drugs have lots of long-term complications, lots, and if you could induce tolerance then that would rule that out because the complications or side effects of the drugs that we take to prevent rejection are not inconsiderable.

MARK COLVIN: Professor Sir Peter Morris, speaking at the 50th anniversary of the first kidney transplant in New South Wales.

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