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MEDICAL BREAKTHROUGHS | KIDNEY TRANSPLANT

Sisters pioneer new kidney transplant at UW that includes immune system

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Brenda Quale, right, donated some of her immune cells, along with a kidney, to her sister Barb Okey, left, at UW Hospital last month. The hope is that Okey will permanently acquire part of Quale's immune system, which could let her avoid anti-rejection drugs, which are costly and have side effects. It was UW's first such kidney and immune system transplant. The sisters, from Platteville, talk with nurse practitioner Scot Johnson during a clinic visit at UW last week.

When Brenda Quale donated a kidney to Barb Okey last month, she gave her something else: part of her immune system.

In a new twist at UW Hospital, some living kidney donors are also parting with blood stem cells, which are infused into the kidney transplant recipients. The goal is to give recipients a dual immunity so they can accept the foreign organ without taking lifelong anti-rejection drugs, which are costly and have side effects, including damage to their kidneys.

“It’s always been a dream to significantly minimize, if not completely eliminate, those medications,” said Dr. Dixon Kaufman, UW Hospital’s transplant chairman. “We believe this will translate into a more durable, better-functioning kidney transplant.”

Quale and Okey, sisters from Platteville, were the first pair to try the new approach at UW Hospital, which is part of a national study.

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Barb Okey gets an infusion of blood stem cells donated by her sister, Brenda Quale, last month at UW Hospital, as nurse Janelle McMannes checks on her. Okey, who received a kidney from Quale in a transplant a week and a half earlier, received the immune cells so she could acquire a partial immune system from Quale. That could let her avoid lifelong anti-rejection drugs.

“Getting off of anti-rejection meds is awesome if I can,” said Okey, 48.

“It will be amazing if it works,” said Quale, 54. “It’s quite a thing to be able to give.”

Nearly 35,000 Americans received organ transplants last year from living or deceased donors. To keep their bodies from rejecting the organs, they permanently take pills to suppress their immune systems, which can increase their risk of infection and chronic diseases, and eventually degrade their new organs.

The study by Medeor Therapeutics — a company in San Mateo, California, that is based on research at Stanford University — substitutes the donor’s immune system for the anti-rejection drugs.

In Madison, the process started in late September, when Quale took injections to boost stem cells in her blood. Nurses collected the cells through a blood filtering machine at UW Hospital.

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Brenda Quale, with nurse practitioner Scot Johnson at UW Hospital last week, said she had significant discomfort after donating a kidney to her sister in early November. But now she's feeling much better and has stopped taking pain medication, she said.

On Nov. 5, Quale donated a kidney to Okey through a regular transplant.

Okey started on anti-rejection drugs, as normal. She also received radiation for 10 days, which typically is not done. The radiation tamped down her immune system and prepared her to accept her sister’s cells.

“We partially suppressed Barb’s immune system to create space for Brenda’s immune system, so that both can intermingle,” Kaufman said.

On Nov. 16, the last day of radiation, Okey received Quale’s immune cells through an intravenous line. The cells had been shipped to Medeor for processing.

Before her infusion, Okey was allowed to stop taking one of three anti-rejection drugs. In a few weeks, she’ll quit another. If all goes well, doctors will wean her off the third one in six months and completely drop it within a year.

Monthly tests will check if Quale’s immune system continues to reside in Okey. Typically, recipients end up with about 85 percent of their immune system and 15 percent from their donor, Kaufman said.

“As long as there’s a portion of her sister’s immune system, which is the same as what her donated kidney sees, it alters Barb’s system so it doesn’t reject the kidney,” he said.

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Barb Okey receives blood stem cells from her sister at UW Hospital on Nov. 16 after getting a kidney transplant from her on Nov. 5. It's part of a national study in which kidney recipients receive immune cells from their donors so the recipients can develop a "chimeric," or dual, immune system. 

So far, the approach is limited to living donors and recipients whose tissue types match perfectly. Of the 100 or so living donor kidney transplants done at UW Hospital each year, only four or five involve perfect matches, Kaufman said.

He is working with Dr. Sam Strober of Stanford to adapt the technique for partially matched or mismatched pairs. Most of that research is in rhesus monkeys, not people. Kaufman and Strober are scientific advisers to Medeor.

Similar studies at some other centers infuse the donor’s blood stem cells into the recipient before the kidney transplant. But Kaufman said doing it afterward could eventually work with deceased, as well as living, organ donors. It’s not possible to select deceased donors and acquire their immune cells far in advance, as it is with living donors.

Quale, a nurse at Southwest Health in Platteville and Upland Hills Health in Dodgeville, wasn’t troubled by giving up immune cells along with her kidney. The cell-boosting injections made her feel like she had the flu, however, and she had significant discomfort after the surgery.

“I’m not going to lie; it was rough. But I’m doing much better now,” she said last week.

Okey is grateful that Quale, one of her four siblings, was medically and emotionally fit to help.

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Sisters at UW Hospital

Barb Okey, left, and her sister, Brenda Quale, both of Platteville, are shown in early November while at UW Hospital for a kidney and immune system transplant. Quale, 54, donated her kidney and some of her blood stem cells to Okey, 48. Okey jokingly wonders if she might acquire some of her older sister's traits. "She likes the bling; I'm more sweat shirts and sweat pants," she said. "I hope it makes me skinny like her." 

Okey developed an inflammatory kidney disease nearly 20 years ago. Last year, it suddenly got worse, prompting her doctor to say she needed a transplant.

The condition made her retain water, causing her arms and legs to swell. She became so tired she could barely make it through the day without sleeping. Despite that, she kept up her job in the laundry department of an assisted-living facility.

Now, even as she continues to recover from her transplant, she already feels better.

“I have more energy than I did before,” she said. “I can stay awake all day.”

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David Wahlberg is the health and medicine reporter for the Wisconsin State Journal.