4 ms·

> Any time we do any transplant immunosupressants are given to the recipient for the rest of their life, but this only slows the inevitable. Is this true that

by johnmaguire2013 7y ago

> Any time we do any transplant immunosupressants are given to the recipient for the rest of their life, but this only slows the inevitable. Is this true that it is inevitable? My understanding, from my girlfriend attending medical school (only M1), is that for many types of transplants, when immunosupressants are taken properly, it is unlikely that the organ will ever be rejected. For example, only 10-20% of patients who receive a kidney transplant will experience rejection[1]. [1] https://columbiasurgery.org/kidney-transplant/organ-rejection-after-renal-transplant https://columbiasurgery.org/kidney-transplant/organ-rejectio...

arkades 7y ago
“Only 20%” and “unlikely to ever be rejected” are worlds apart. Modern immunosuppressive therapy for, for instance kidneys, has dropped the five year acute rejection rate from 50% to 20%. About 8-10% in the first year. You can get a 5% 10-year non-rejection rate only in the most hand-picked groups (adheres to meds, no underlying systemic disease, and no chronic nephropathy). That sub-population exists, but it’s pretty uncommon.
- sandworm101 7y ago
  People without underlying disease generally dont need or get replacement organs. These are all complex cases. Only in the most rare of circumstances does an otherwise totally healthy person need a new kidney.
  - capnslowish 7y ago
    Focal glomerulosclerosis destroys kidneys in a completely healthy person.
- johnmaguire2013 7y ago
  > “Only 20%” and “unlikely to ever be rejected” are worlds apart. The parent comment I responded to stated it was "inevitable." "Inevitable" and "only 20%" are many more worlds apart than "unlikely to ever be rejected" and "only 20%". "Unlikely" is a bit subjective, but it is well below a coin flip. I cited a source for the statistics. If you disagree, can you please cite your source?
rcthompson 7y ago
Even if there is no acute rejection event, long-term accumulation of damage from the host's immune system attacking the graft at a low background level is still very likely. Immune suppression has to walk a tightrope that in addition to being very thin is also constantly moving around. Each time you get sick, if your immune suppression is too aggressive, you might just die. If it's not aggressive enough, the pro-immune signalling generated in response to the infection might override the immune suppression and trigger rejection of the graft. Any other event that triggers or suppresses an immune response also has similar risks associated with it. It's kind of similar to how diabetes patients need to constantly monitor their blood sugar and manually adjust their insulin levels to compensate, but on a longer time scale (generally weeks to months rather than minutes to hours). But with diabetes, at least you have the potential for almost direct control over your blood sugar levels (by regulating food intake). There is no such direct control for your level of immune activity, nor is there a simple and quick blood test to measure whether immune suppression is at the right level. In short, anyone with a transplant is walking a wobbly tightrope of immune suppression for the rest of their life, and they sometimes don't even know they've fallen off until they hit the ground. (Source: I have previously worked in a lab studying transplant rejection and trying to, among other things, develop such a simple and quick blood test: https://www.ncbi.nlm.nih.gov/pubmed/24725967 https://www.ncbi.nlm.nih.gov/pubmed/24725967)
- lr4444lr 7y ago
  There was some talk a while back about using a modified form of HIV to suppress immune response for transplant recipients. Any update on that?
  - rcthompson 7y ago
    I don't have any specific knowledge about that. Our lab was mainly focused on diagnostics for transplant rejection, with the idea being that a quick and easy test for rejection would allow immune suppression to be adjusted more accurately and more often, since the current standard test is a tissue biopsy manually inspected by a specialist, which is not something you can do very frequently for a number of reasons.

arkades 7y ago

“Only 20%” and “unlikely to ever be rejected” are worlds apart. Modern immunosuppressive therapy for, for instance kidneys, has dropped the five year acute rejection rate from 50% to 20%. About 8-10% in the first year. You can get a 5% 10-year non-rejection rate only in the most hand-picked groups (adheres to meds, no underlying systemic disease, and no chronic nephropathy). That sub-population exists, but it’s pretty uncommon.

sandworm101 7y ago
People without underlying disease generally dont need or get replacement organs. These are all complex cases. Only in the most rare of circumstances does an otherwise totally healthy person need a new kidney.
- capnslowish 7y ago
  Focal glomerulosclerosis destroys kidneys in a completely healthy person.
johnmaguire2013 7y ago
> “Only 20%” and “unlikely to ever be rejected” are worlds apart. The parent comment I responded to stated it was "inevitable." "Inevitable" and "only 20%" are many more worlds apart than "unlikely to ever be rejected" and "only 20%". "Unlikely" is a bit subjective, but it is well below a coin flip. I cited a source for the statistics. If you disagree, can you please cite your source?

rcthompson 7y ago

Even if there is no acute rejection event, long-term accumulation of damage from the host's immune system attacking the graft at a low background level is still very likely. Immune suppression has to walk a tightrope that in addition to being very thin is also constantly moving around. Each time you get sick, if your immune suppression is too aggressive, you might just die. If it's not aggressive enough, the pro-immune signalling generated in response to the infection might override the immune suppression and trigger rejection of the graft. Any other event that triggers or suppresses an immune response also has similar risks associated with it. It's kind of similar to how diabetes patients need to constantly monitor their blood sugar and manually adjust their insulin levels to compensate, but on a longer time scale (generally weeks to months rather than minutes to hours). But with diabetes, at least you have the potential for almost direct control over your blood sugar levels (by regulating food intake). There is no such direct control for your level of immune activity, nor is there a simple and quick blood test to measure whether immune suppression is at the right level. In short, anyone with a transplant is walking a wobbly tightrope of immune suppression for the rest of their life, and they sometimes don't even know they've fallen off until they hit the ground. (Source: I have previously worked in a lab studying transplant rejection and trying to, among other things, develop such a simple and quick blood test: https://www.ncbi.nlm.nih.gov/pubmed/24725967 https://www.ncbi.nlm.nih.gov/pubmed/24725967)

lr4444lr 7y ago
There was some talk a while back about using a modified form of HIV to suppress immune response for transplant recipients. Any update on that?
- rcthompson 7y ago
  I don't have any specific knowledge about that. Our lab was mainly focused on diagnostics for transplant rejection, with the idea being that a quick and easy test for rejection would allow immune suppression to be adjusted more accurately and more often, since the current standard test is a tissue biopsy manually inspected by a specialist, which is not something you can do very frequently for a number of reasons.