Kidney Transplant Patients Provided With New Hope - Use of Normothermic Machine Perfusion With Stem Cells

Highlights :

Marginal kidney functions can now be improved with Normothermic Machine Perfusion and Adult Stem Cell Therapy
Increases blood flow and urine production
Production of anti-inflammatory molecules
Avenues open to pre-treat kidneys without any side effects to the patient.

Normothermic Machine Perfusion (NMP) combined with adult stem cells has been found to increase the function of marginal kidneys by the release of anti-inflammatory molecules leading to an increase in blood flow and urine production. The study primarily aims to increase the quality and number of kidneys available for transplantation and reducing kidney wait times.

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‘New hope for kidney transplantation patients as normothermic machine perfusion along with adult stem cells, show promising results of an increase in function and lifespan of donor's kidneys. New avenues of research open with the possibility of pre-treat kidneys.’
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What is the Current Scenario of Kidney Transplantation?

Kidney transplantation provides the best quality of life and long term outcomes for patients with kidney failure. However, there is a huge gap between the demand and supply for kidney transplantation. The UK kidney transplantation waiting list is over 5,000 patients and in the USA it is over 100,000.

At the same time, almost 2,000 kidneys are discarded in the USA year due to the poor quality of the kidneys and patients can wait over three to five years for a kidney to become available.

As the demand is high sometimes even very marginal kidneys are offered for donation. These often lead to post-transplant problems, which increases the chances of the patient needing a second transplant or going back on dialysis.

Adult Stem Cells
Stem cells are progenitor cells that have the potential to grow into other types of cells.

How was the Study Conducted?

The study was led by Dr. Emily Thompson, studied the effect when a new technique called Normothermic Machine Perfusion was combined with stem cells on the marginal kidney.

Dr. Thompson is funded by Kidney Research UK and by the NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation. The research is published in the American Journal of Transplantation.

Normothermic Machine Perfusion (NMP) is a new methodology for organ preservation and has often been used with liver transplantation to improve graft quality. It pumps oxygenated blood through the organ at body temperature optimizing metabolism for storage and transportation.

The advantages of NMP are:

The kidney has less insults of storage in ice or when it is getting rewarmed, as NMP maintains normal conditions outside the body
Reduces chances of non-function or delayed graft function in the patient

In the study, kidneys were treated with stem cells known as Multipotent Adult Progenitor Cells (MAPC). MAPC is adult, bone-marrow-derived, mesenchymal origin, stromal cells. MAPC cells were obtained from Athersys Inc and called Multi Stem cultures.

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What did the Study Observe?

The treated kidneys showed several responses associated with better function:

Improvement of physiological parameters and biomarkers of kidney injury
Higher volume of urine output
Significant improvement in micro vascular perfusion
Reduced the release of anti-inflammatory molecules- cytokines and growth factors specifically reduction of IL-1beta, increase in IL-10 and IDO activity.

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Conclusion

In summary, this is the first study to use NMP with stem cells to improve the function of marginal kidneys. This study opens new avenues that enable researchers to pre-treat the kidney directly. It also provides opportunities to explore other therapies like gene therapy or other stem cells. The research team hopes for a better quality of kidneys with longer-lasting time when the patient undergoes transplantation. It may also reduce the discard rates of the unused kidneys in the program.

Dr. Thompson has already been recognized for this study by receiving the Medawar medal from the British Society and the Da Vinci award from the European Society of Transplantation.

Reference:

Novel delivery of cellular therapy to reduce ischemia reperfusion injury in kidney transplantation - (https://onlinelibrary.wiley.com/doi/full/10.1111/ajt.16100)

Source-Medindia