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Thomas Pearson

Improving long-term outcomes after kidney transplant

Twenty years of research and you start to improve outcomes for transplant patients.

The Nature paper from Chris Larsen and Tom Pearson on “costimulation blockers” and their ability to head off graft rejection in rodents first appeared in 1996.

Almost 20 years later, a seven-year study of kidney transplant recipients has shown that the drug belatacept, a costimulation blocker based on Larsen and Pearson’s research, has a better record of patient and organ survival than a calcineurin inhibitor, previously the standard of care.

Kidney transplant recipients need to take drugs to prevent their immune systems from rejecting their new organs, but the drugs themselves can cause problems. Long-term use of calcineurin inhibitors, such as tacrolimus, can damage the transplanted kidneys and lead to cardiovascular disease and diabetes.

In the accompanying video, Larsen - now dean of Emory University School of Medicine – and Pearson - executive director of Emory Transplant Center – explain.

Belatacept was approved by the FDA in 2011 and is produced by Bristol Myers Squibb. Results from the BENEFIT study of belatacept, led by Larsen and UCSF transplant specialist Flavio Vincenti, were published in the Jan. 28 issue of the New England Journal of Medicine.

To go with the paper, NEJM has an editorial with some revealing statistics (more than 14,000 of the 101,000 patients listed for kidney transplantation are waiting for a repeat transplant) and a explanatory video. MedPage Today has an interview with Larsen, and HealthDay has a nice discussion of the issues surrounding post-transplant drugs. Read more

Posted on by Quinn Eastman in Immunology Leave a comment

Catching up on Emory transplant advances

While preparing to discuss Ebola virology with Emory infectious disease specialist Aneesh Mehta next week, we noticed two recent research papers on which he is a co-author. Both have to do with organ transplantation, since Mehta is Assistant Director of Transplant Infectious Diseases.

Fecal microbiota transplantation for refractory Clostridium difficile colitis in solid organ transplant recipients

Fecal transplant is gaining ground as a remedy for C. difficile-driven diarrheal infections, which can appear in patients whose normal intestinal bacteria are wiped out by antibiotics. Fecal transplant has not been widely studied in organ transplant recipients, who must take drugs to keep their immune systems from rejecting the transplanted organ, because of concerns about infectious disease complications. This paper describes two patients, one a lung transplant recipient and one a kidney transplant recipient, who received fecal transplants to resolve their C. difficile diarrhea without complications. The lead authors are infectious disease specialists Rachel Friedman-Moraco and Colleen Kraft. Kraft has been a pioneer in this area of research.

Renal transplantation using belatacept without maintenance steroids or calcineurin inhibitors

Medical school dean Chris Larsen and Emory Transplant Center executive director Tom Pearson (both co-authors) were key members on the team that developed belatacept, a FDA-approved drug since 2011. Belatacept was designed to get away from the cruel paradox where a kidney recipient, to prevent transplant rejection, has to take calcineurin inhibitor drugs that slowly poison the kidney and cardiovascular health. Belatacept inhibits the immune response by a different mechanism. Yet transplant specialists have generally been cautious in moving toward a regimen that relies on it.

As reported in this paper, Emory transplant doctors took off the training wheels, aiming to get to the point where kidney transplant recipients are taking a once-a-month infusion of belatacept only. With some patients, it was possible to reach that goal, but not all. In fact, as the authors describe, some patients chose not to try to wean themselves off the other drugs, and doctors advised against the attempt for a handful. This clinical trial was also notable because some transplant recipients received immune-educational cells from their organ donors in the form of bone marrow.

The lead author, former Emory Transplant Center scientific director Allan Kirk, moved to Duke this spring.

Posted on by Quinn Eastman in Immunology Leave a comment

Transplant nursing pioneer revisits Emory Transplant Center, 45 years later

Millie Elliott

Nearly 45 years after she cared for Georgia’s first organ transplant recipient, Millie Elliott, 84, visited the Emory Transplant Center outpatient transplant clinic to see how things have changed since her time at Emory. Elliott, who was Millie Burns at the time, worked at Emory University Hospital first as an obstetrics nurse, then as head nurse of an NIH-sponsored clinical research unit at Emory from 1961 to 1967. She served as a dialysis nurse on that unit and may have been the Southeast’s first renal transplant coordinator.

During her recent visit to Emory, this former Cadet Nurse Corps nurse and World War II veteran regaled the transplant center staff and kidney transplant program director Thomas Pearson, MD, PhD, with her stories about the first transplant at Emory. Elliott recalled spending a lot of time researching medical sources to prepare herself and her nurses for that remarkable day. The first transplant patient was a 16-year -old boy with renal failure who received a donor kidney from his father.

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Posted on by Holly Korschun in Uncategorized Leave a comment