For decades, steriod medications have been an essential part of preventing organ rejection after transplantation. Early indications from an exciting research trial underway at Saint Barnabas Medical Center’s Renal and Pancreas Transplant Center suggest that steroids – and the serious complications that come with them — can be avoided.
 Thymoglobin, a medication that has been used with great success to reverse episodes of rejection, is now being tested for its potential to prevent organ rejection. “It appears that the slow, prolonged and predictable effect of thymoglobin can prevent the need for steroids in some transplant recipients,” says Shamkant Mulgaonkar, M.D., Chief of the Saint Barnabas Transplant Centers.
Steriods have been a major ingredient in transplant medicine because without them, 40 percent of recipients reject their transplanted organ. Transplant professionals have been seeking a substitute for steroids for many years because long-term use can cause diabetes, high cholesterol, heart disease, bone loss, mood swings, and significant weight gain. “The only major health complaints of thousands of people whose kidney transplants have been successful for ten to twelve years or more are related to the prolonged use of steroids,” explains Dr. Mulgaonkar. “If we can eliminate the need for steroids, we can improve longevity and the quality of life.”
Joseph Fischetti, 57 of Madison, NJ, was one of the first transplant recipients at Saint Barnabas to begin the new protocol that included injections of Thymoglobin before his transplant in June 2003. “I am feeling fantastic and my new kidney has been functioning well,” says Mr. Fischetti. He says he agreed to participate in the research trial because he has great trust in Dr. Mulgaonkar and the transplant team, and because during several weeks of dialysis treatments, he witnessed the difficulties that other patients suffered because of steriods. “When Dr. Mulgaonkar told me I might be able to avoid all of those side effects, I didn’t hesitate. I am very lucky. I was home in 4 days — had hardly any pain and no complications at all.”
Mr. Fischetti’s renal failure was caused by polycystic kidney
disease (PKD), a genetic disorder that causes the
growth of hundreds of cysts on both kidneys and
a steady decline in organ function. “Mr. Fischetti was a good
candidate for this research trial because this
was his first transplant, he had a living donor,
he had never been on steroids, and except for his
kidneys he was otherwise very healthy,” reflects Dr. Mulgaonkar.
Symptoms of PKD are usually detected by the time a person is 30
years old. Patients can manage the disease for
years with the guidance of a nephrologist, and
have time to consider and plan for a transplant
as the disease progresses. In Mr. Fischetti’s case he discovered
he had polycystic kidney disease when he was in
his 30s and began to consider his option for transplantation.
Mr. Fischetti’s son Michael offered to donate a healthy kidney
when his father’s renal function dropped to 10 percent in 2002. “People
with PKD generally do very well after transplant,” notes Dr.
Mulgaonkar. Scientists have identified the gene
associated with the disease, and have developed
testing that can identify it long before any symptoms
are felt. If you or anyone in your family has been
diagnosed with PKD, you can learn more by contacting
the PKD Foundation at 800-PKD-CURE or visiting
the web site at www.pkdcure.org.
Dr. Mulgaonkar points out that not everyone is a candidate for the
Thymoglobin research trial and that the results
from this ongoing study are still being compiled
at leading transplant centers throughout the United
States. Yet, he is confident that this research
is a major step in understanding the human immune
system and improving the outlook for all transplant
recipients.
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