Times of India
09 September 2010
By Avanindra Mishra
Jaipur, India

The SMS Medical College here has added yet another feather in its cap by being the first hospital in the country to have successfully carried out a kidney transplant with stem cell technology.

The surgery was conducted on a 35–year–old man on June 11 who has now been taken out of post–transplant medication. He may not require any future medication and has been showing steady recovery, said doctors.

"It is the second only such procedure recorded in the world where a transplant patient has been completely withdrawn of the post–transplant drugs," said Dr L C Sharma, head of the department of nephrology.
The immunity level of the patient, Hari Singh – a Jhunjhunu resident – against other diseases is also much better and doctors expect the transplanted kidney to last longer. According to doctors, nine weeks past the operation, they have stopped the use of immunosuppressant medications and he may not require regular intake of medicines unlike other patients of kidney transplant.

"A patient’s body looks at the kidney as a foreign body and tries to damage the transplanted organ. The immunosuppressant medications are thus necessary for an ordinary kidney transplant patient," said Dr Sharma.

However, injection of the stem cell in the patient helps in developing a harmony between the patient’s body and the transplanted organ. Thus, the need of immunosuppressant drugs is reduced.

Though such attempts have previously been made in Gujarat, they they have been unable to reach complete independence from the immunosuppressant treatment post the transplant, said doctors.

Hari Singh was diagnosed with a kidney failure in 2009 and was referred to SMS hospital in March 2010. The doctors at nephrology department selected him for the innovative treatment as he was to receive the kidney from his mother, which is a more suitable case for the new technique.

Stem Cell Technology
The use of immunosuppressant drugs is done to regulate the number of CD4 cells (specialised white blood cells that play an important role in the body’s immune system).

A patient with a regular kidney transplant thus not only have a lifelong dependency on drugs, he also faces immunity deficiency. The stem cell technique, on the other hand, enables to develop a harmony between the body cells of the recipient and the donated organ. Thus, there remains no necessity for continuous suppression of the immunity cells.

The Process

1. The recipient (Hari Singh) was given total lymphoid irradiation to reduce the count of harmful T cells (CD4).
2. The stem cells were extracted from the bone marrow of the donor (Hari Singh’s mother) just before the transplant process. The extracted stem cells were treated with antibody dependent cellular cytotoxicity (ADCC) process to separate the harmful cells.
3. The stem cells were infused via central veins line in the peripheral blood of the recipient before the transplant on June 11, 2010. After the transplant, cyclophosphamide and fludarabine were given to the patient to reduce the CD4 cells. These quantity of the two drugs were gradually reduced before being completely stopped on August 31.
4. The patient is under continuous medical observation and has registered steady recovery. Even the CD4 cell count is now nearly normal with no adverse effect on the transplanted organ over the past 8 days

Stem cell technology is still in research phase, say docs
Jaipur: The proposal for the surgery was presented at the Indian Council for Medical Research (ICMR) and it was approved by a 19–member team after an evaluation of all the possible aspects. The transplant was done by Dr P C Sadasukhi of urology department, SMS hospital while Dr L C Sharma and Dr Shimon Slavin from Israel were chief advisors.

With an aid of nearly Rs 8.5 lakh from ICMR, two kidney transplants were held on June 11. While the first patient (Hari Singh) received the kidney through the stem cell technology, the other got it through regular technique.

In both the cases, the transplant cost was around Rs 2 lakh. However, the patient with regular transplant still has to take immunosuppressant drugs of nearly Rs 1.5 lakh per year. The stem cell patient, on the other hand, has shown steady recovery and does not require any sort of medication.

However, doctors have kept him under regular observation as the technique is still in research phase.

Despite the benefits the process is still under research stage and it will only after studying the results over next few years that the facility is expected to become available for the common patients. SMS Medical College has received permission to perform only one such operation. However, following the success, it is expected that they may be allowed to repeat it on a couple of other patients.

"The first such operation was reported from a medical school in Boston. As part of the process, five patients were transplanted using the process. Of these, four were withdrawn from the immunosuppressant drugs in duration of nearly one year. The kidney functionality of the patients were found unaffected even after a couple of years," said Dr L C Sharma.