Here we go again – retransplantation

December 5, 2011

A small number of patients on the waiting list for organ transplants have played the waiting game before. Those people are waiting for their second  transplant, often called a “retransplant.”

According to a 2008 study by the University of Michigan, as more Americans have organ transplants, the total number of retransplant patients has steadily risen. However, the percentage of patients waiting for their second transplant has remained steady, at about 11 -13 percent.  

The largest number of retransplants are kidney patients. One reason is that kidney transplants are far and away the most common transplant operation. And if a transplanted kidney fails, patients have dialysis to fall back on. Mechanical support systems for other organs aren’t as successful or accessible.

There are a few reasons that someone can need a second transplant. The most common is organ rejection. Although anti-rejection therapy is constantly advancing and individual immune suppressant regimens can be fine-tuned, patients can still develop rejection at any time.

This is especially true of lung transplant patients. In fact, almost half of all lung transplant patients develop chronic rejection about five years after their transplant. Unless this rejection is controlled or stabilized with medication or photopheresis therapy, the patients may find themselves with no other option but to have a second transplant.

Unfortunately, the statistics show that except for second kidney transplants, the survival rates for second transplants of other organs are worse than for first transplants. 

The choice whether to try for a second transplant is a highly personal one. Some patients decide not to embark on a second transplant journey. Others, like Tom Nate, whose story we shared recently, feel strongly about trying for another transplant. Patients are encouraged to make the choice that’s right for them.

Here’s the story of a Columbus, OH, woman who has also decided to take another chance:

Should transplant patients get flu shots?

October 17, 2011

Roll up your sleeves, transplant patients! You need your flu shot – maybe more than other folks.

This comes from Dr. Ramsey Hachem, Washington University pulmonologist at Barnes-Jewish Hospital.

People seem to have excuses every year as to why they don’t need a flu shot – flu shots make them feel sick, they never get the flu, it’s inconvenient, they’re just tired of getting stuck.

Sorry, we aren’t buying any of it.

Influenza is a deceptively devastating illness. For many of its victims, it’s ends up being a week or two of fever, aches, chills, sore throat, coughing and general misery. 

But for people with weakened immune systems, it can be much worse, says Dr. Hachen.  Transplant patients, this means YOU.

People on immunosuppressants are more likely to catch the flu, he says. Then, in these patients, the flu is more likely to lead to complications  including sinus and ear infections and pneumonia. These complications, in someone whose immune system is impaired, are more likely to be severe and lead to hospitalizations.

The Centers for Disease Control’s flu information site recommends that EVERYONE over age six months get vaccinated.

The only caveat, says Dr. Hachem, is that transplant patients, ideally, should get a vaccine with a dead virus. Flu vaccines work by using dead influenza viruses to  trick the body into making antibodies against the flu. The only exception is inhaled vaccine, or FluMist, which uses a weakened live virus.

The problem with FluMist is that in rare cases, it can actually cause flu symptoms. Although it’s unlikely to cause the actual illness, transplant patients and others with weak immune systems shouldn’t take the chance.

S0, if you haven’t already, get that shot and stay healthy through this flu season.

There are still opportunities to get free flu shots supplied by the Foundation for Barnes-Jewish Hospital. Check here for dates and times.

Stanford study shows promise in weaning patients off anti-rejection drugs

October 7, 2011

It’s a given. Immunosuppressant medication is the cornerstone to successful organ transplant. Without it, a patient’s body would reject the transplanted organ, causing it to fail.

A new study shows that might not always be the case.

A short letter in the Oct. 6 issue of the New England Journal of Medicine tells of a small study at Stanford in which eight out of 12 kidney transplant patients were successfully weaned off of their immunosuppressants.

The patients were given a post-transplant regimen of radiation and donor stem cells, which temporarily blinded the body to the foreign tissue transplanted into it.

While the study is small, it gives hope that, eventually, transplant patients will no longer have to rely on daily medications (some of which can cause severe side effects, themselves) to keep them healthy.

Among those who would welcome a breakthrough in immune suppression therapy is Washington University nephrologist Daniel Brennan, MD, the medical director of kidney transplant at Barnes-Jewish Hospital.  Dr. Brennan is known in the transplant community as an innovator in the field of immunosuppression. Hear his take on his role in the transplant process.

-Kathryn Holleman


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