Advances in Immunotherapy Available at UA Help Transplant Patients Resist Rejection

New advancements in immunotherapy mean UA surgeons and physicians are able to offer patients with existing antibodies or differing blood types a better chance to receive and keep their gift of life.
Nicole Drissi and dog QuincyNicole Drissi, a 29-year-old diabetes patient from Tucson, needed a pancreas and kidney transplant. But antibodies from an earlier failed transplant and from blood transfusions meant she almost certainly would reject new organs.
Through cutting-edge immunotherapy, including the use of a chemotherapy drug, the University of Arizona Abdominal Transplant team was able to reduce Drissi’s antibodies, allowing her to receive a new pancreas and kidney in September.
Dr. Bruce KaplanGustavo Chavez’s kidneys were destroyed as a young child by obstructive uropathy, which causes urine to be blocked. Chavez, 46, who lives in Yuma, received his first kidney at age 11. Subsequently, he received three more transplants over the next 20-plus years, two from deceased donors and one from his brother, each time increasing his antibodies and risk of rejection. 
Today, new, improved treatments to lower antibodies directed against transplanted tissue mean that subsequent transplants are now as likely to be as successful as first transplants. Doctors believe that Chavez’s fifth kidney transplant in June, this time from another brother, could be his last.
In recent years, researchers have discovered that antibodies a patient develops through previous transplants, transfusions or infections can result in damage and eventual rejection of a new organ. But new advancements in immunotherapy mean UA surgeons and physicians are able to offer patients with existing antibodies or differing blood types a better chance at transplantation, explained Rainer Gruessner, MD, professor of surgery and immunology, chairman of the UA Department of Surgery and chief of Abdominal Transplantation at UMC. 
Bruce Kaplan, MD, UA chief of nephrology, medical director of UMC transplant services and professor of medicine, pharmacology and surgery, said that science, along with careful use of anti-rejection medication, will result in improved long-term success, allowing people to live long, healthy lives.
Nicole Drissi’s Story
A few years ago, patients like Nicole Drissi had little hope of receiving desperately needed organ transplants.
Drissi was diagnosed with Type 1 diabetes at age 7, and her diabetes was difficult to control. By age 24, doctors recommended a pancreas transplant. As she waited for a transplant, her kidneys failed from consequences of her diabetes, and a very ill Drissi now needed a pancreas and kidney transplant.
“Nicole really needed this transplant,’’ said Dr. Kaplan. “She wanted it badly. She was doing so poorly on dialysis.’’
“I didn’t have much of a life,’’ said Drissi, who spent as many as 16 hours each week on dialysis, with poor results. “I wasn’t able to go out with friends. I wasn’t able to work. I wasn’t able to exercise or do much of anything.’’
Dr. Kaplan brought the latest advances in transplant medicine with him when he joined the UA two years ago. He was able to use drug therapy to make such a complex transplant a reality.
Dr. Kaplan, along with Dr. Gruessner and the transplant team,combined the chemotherapy drug bortezomib with other therapies to reduce antibodies likely to cause rejection. Bortezomib traditionally is used in patients with multiple myeloma, or cancer of the plasma cells. The drug targets antibody-producing plasma cells that can cause organ rejection.
While the drug made her very ill, Drissi was willing to try immunotherapy if it gave her a chance at a transplant. Without treatment, Drissi had a 5-percent chance of keeping a transplanted organ and would not have been a candidate. And without the transplant, her prognosis was poor.
“It worked incredibly well,’’ Dr. Kaplan said. “She never would have been able to have a transplant without it.’’
Following immunotherapy, Drissi received the pancreas and kidney of a 24-year-old Los Angeles man. UA transplant surgeon Tun Jie, MD, performed the surgery.
The days and weeks following transplant were uncertain. But after 34 days in the hospital, she is home and feeling good for the first time in years.
“It was worth it,’’ Drissi said. “I would do it all over again.’’
Drissi no longer suffers from diabetes.
“Isn’t that something, after 22 years,’’ said her grandmother, Gracie Feckner.
Drissi and her boyfriend, Nathan, recently were able to take a vacation. And she’s planning to return to school. “I always wanted to go to medical school, but my health was not good enough,’’ Drissi said. She plans to study medicine at the UA.
Dr. Kaplan said Drissi will need to be monitored closely throughout her life. It is expected that she again will produce antibodies that could cause her to reject the organs. But therapies can be used to prevent rejection.
Dr. Gruessner said the science surrounding transplants is changing rapidly. “The technology and our immunological understanding has advanced enormously and it keeps galloping along. New and constantly evolving therapies at the UA provide the best possible treatment for patients who need transplants,” he said.
“It’s something we offer in a thoughtful way that wasn’t offered before,’’ Dr. Kaplan said. “It takes a fair amount of expertise, everyone working together to make it work. And it’s worked very well for Nicole.’’
“I feel like I have a new life,’’ Drissi said.
The Comprehensive Transplant Program at University Medical Center in Tucson has been improving the lives of patients in need of organ transplant for more than 40 years. UMC is the only facility in the Southwest with the ability to transplant all solid organs – heart, lung, kidney, liver, pancreas and small bowel – as well as islet cells to both adult and pediatric patients.