Cyclosporine and the era of discovery surrounding it has brought tremendous advances to the highly specialized field of transplantation. The next giant leap in the field may prove even more challenging: It would require a staggering 48,000 organs to remove all the people from dialysis who are presently seeking renal transplant in this country alone. Today’s physicians and scientists are focusing their research on providing more organs, eliminating the need for so many medications to maintain a transplanted organ, and extending the life of a transplanted kidney beyond the present 10-year average.
Beyond Cadaveric Organ Donation
Public awareness and education about organ donation over the last two decades has risen, but organ procurement agencies throughout the United States have reached a plateau. Clearly, the need for healthy kidneys cannot be met by cadaveric donation alone. “For this reason, current research and developments in the field of xenotransplantation – transplantation between species – is being viewed with great optimism,” says Shamkant Mulgaonkar, M.D., Chief of the SBHCS Renal and Pancreas Transplant Centers. The creation of transgenic pigs (genetically altered to better match the human immune system) may eliminate hyperacute rejection experienced in humans in the minutes and hours immediately following xenotransplantation. Significant progress has been made to define and understand the mechanisms of recognition and rejection of xenogenetic cells and organs. This progress will someday make transplantation between species a clinical reality.
Another alternative to help supplement the critical shortage of cadaveric kidneys involves the creation of a living donor registry similar to the existing bone marrow registry. Within a highly organized, scientific and ethical system, living donors may soon be able to step forward to offer a lifesaving kidney to someone they have never met. “Many people have expressed a desire to donate kidneys to their loved ones, but if the blood or tissue types do not match, transplantation is not feasible,” explains Dr. Mulgaonkar. “Through a living donor registry, these willing donors could provide another valuable source of healthy kidneys for other more suitable recipients.”
Clinical Trials – Testing Tomorrow’s Medications
 According to Dr. Mulgaonkar, another major thrust of today’s research is to lessen the need for costly immunosuppressive drugs and the negative side effects associated with them. “Scientists are exploring more about immunology and how the human body tolerates its own organs. If we can discover how to make a foreign organ act like the recipient’s own through manipulation of their immune system, without causing harm, then we wouldn’t need the arsenal of medications we now require.”
SBHCS Renal and Pancreas Transplant Centers are the only centers in New Jersey directly involved in the research and development of new drugs and protocols that will extend graft survival, prevent and treat rejection and reduce or eliminate other complications. Research efforts are particularly compelling in patients over the age of 60, who face a different set of challenges with organ transplantation. “Through our research, we have identified an important physiological change within this patient population. Specifically, their immune systems are not as active as a young person’s. Based on that notion alone, clinical drug trials are now underway with new protocols that are less intense and reduce complications for transplant recipients in this age bracket,” states Dr. Mulgaonkar.
On another front, clinical trials will begin in late 2000 for a new drug that does not cause immunosuppression, but rather, herds the T-lymphocytes – the white cells responsible for attacking a foreign organ and causing organ rejection – away from the transplant organ.
Other research studies conducted at the SBHCS Renal and Pancreas Transplant Centers into the effectiveness and safety of Simulect, an immunosuppressive drug recently approved by the FDA, were invaluable in securing the drug’s release on the market. SBHCS Renal and Pancreas Transplant Centers also served as one of the largest centers participating in the phase-I trial of another newly developed agent designed to treat organ rejection with fewer side effects.
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