Pushing the boundaries with translational research in liver transplantation
As important as treatment expertise, the NewYork-Presbyterian Liver Transplant Team is working on clinical trials exploring liver transplant tolerance, minimizing and individualizing immunosuppression to improve outcomes and quality of life. .
Although most transplant cases require immunosuppression, many complications occur associated with excessive immunosuppression, including hypertension, diabetes, kidney disease, cancer, and recurrent infections. The challenge for liver transplant physicians is to minimize and individualize the amount of immunosuppression required by patients. Researchers are investigating the use of biomarkers to personalize immunosuppression to individual patients.
NewYork-Presbyterian is also leading groundbreaking research into transplant tolerance, where recipients receive transplanted organs without immunosuppression. “Transplant tolerance is the holy grail of transplant research and a core subject of translational research at NYP,” says Dr. Emond. “Our hope is that five years from now, and definitely 10 years from now, children will be able to undergo liver transplants without the need for anti-rejection drugs.”
To achieve this goal, the liver transplant team is working closely with Megan Sykes, M.D., director of the Columbia Center for Translational Immunology (CCTI) and director of research for the Transplant Initiative, to advance the immunology We study one concept: natural tolerance. Patients are naturally tolerant. and the design of new interventions to modify patients before transplantation to achieve tolerance.
One tolerance intervention is currently being studied in the pivotal PANORAMA trial. This clinical trial is investigating the human anti-CD2 antibody ciplizumab in combination with donor bone marrow cells and non-myeloablative conditioning to induce tolerance in living kidney transplants. The protocol for this study is based on the research of Drs. Sykes and CCTI Professor of Surgery David Sachs have demonstrated in humans that combining bone marrow and kidney transplants, which fuse the immune systems of the donor and recipient, can lead to tolerance. In previous studies, patients suffered from chimeric transition syndrome, a severe immunological side effect that can damage newly transplanted kidneys. However, new protocols are designed to avoid these complexities. If proven successful, this new approach could induce tolerance in other types of organ transplants.
