PITTSBURGH, Jan. 27 -- A number of papers are being presented by
University of Pittsburgh Medical Center (UPMC) researchers at the Society of
Thoracic Surgeons Thirty-Fifth Annual Meeting Monday, Jan. 25, through
Wednesday, Jan. 27, in San Antonio. Following are highlights of clinical
findings that will be presented:
Incidence Of Chronic Rejection Less For Lung Recipients Who Receive Bone Marrow
Simultaneous infusion of donor bone marrow at the time of lung transplantation significantly reduced the incidence of obliterative bronchiolitis, the telltale marker for chronic rejection that prevents air exchange in the lung's bronchioles, UPMC researchers will report on Wednesday, Jan. 27.
Between 1993 and 1997, UPMC surgeons gave 26 patients infusions of bone marrow at the time of their lung transplants and compared their outcomes with 13 patients who did not receive donor bone marrow. The recipients of the bone marrow did not undergo any radiation treatment, nor was the bone marrow modified in any way. Both groups of patients received standard anti-rejection therapy of tacrolimus (Prograf) and steroids.
To date, survival for both groups is at 69 percent, reports Si Pham, M.D., who led the UPMC study. Results indicate the bone marrow infusion was safe; no patient developed graft vs. host disease (GVHD) or any other complication associated with the bone marrow infusion. GVHD is a complication that involves donor immune cells attacking recipient tissues.
Patients who survived beyond three months were also monitored for obliterative bronchiolitis (OB), which is caused when the immune system of the recipient rallies its white blood cells in an attack against the foreign donor organ. The cells specifically target, and essentially clog, the lung's bronchiole tissue. In the patients who did not receive bone marrow, the incidence of OB was 30.8 percent, compared to 4.7 percent in those patients who received the infusions.
"Obliterative bronchiolitis is often difficult to treat and can have deadly consequences. This study shows that not only is bone marrow infusion safe, but that it might be able to reduce the risk for OB," says Bartley P. Griffith, M.D., professor of surgery and chief, division of cardiothoracic surgery.
Simultaneous bone marrow infusion at the time of solid organ transplantation is a major area of clinical research at the UPMC. Researchers are interested in learning how chimerism -- the coexistence of donor and recipient cells -- affects long-term organ acceptance. They have already determined that levels of chimerism can be significantly increased with donor bone marrow infusions, having performed the procedure in more than 225 patients who underwent liver, kidney, pancreas, intestine, lung or heart transplants.
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