Singapore doctors find the 'Holy Grail' in transplant
November 11, 2005
One is a pre-leukaemic disease, which affects 230 Singaporeans a year. The other is renal failure, which is the seventh biggest killer Singapore, accounting for 1.6 per cent of all deaths in 2002.
But a team of specialists from The Cancer Institute, National Healthcare Group (NHG) and the National University Hospital (NUH) have successfully tackled both problems by performing the first kidney and bone marrow transplant in Asia.
It is a procedure that could have wide-reaching implications for kidney transplants in the future.
Their patient, 43-year-old Koh Hock Heng, was suffering from both kidney failure and a stem cell disease called myelodysplastic syndrome (MDS).
"MDS is a pre-leukaemic disease in which the bone marrow doesn't function properly. It needs intensive chemotherapy and treatment can be quite toxic, which is not possible for someone with renal failure," said Dr Pary Sivaraman, Consultant Renal Physician, Department of Medicine (NUH).
The cause for the disease is not known, but incidences increase in an ageing population. If MDS progresses to leukaemia, the patient does not respond to chemotherapy and succumbs to the cancer.
The solution was to turn to non-myeloablative stem cell transplantation (NMT), which involves using significantly lower doses of chemotherapy and radiation compared to standard bone marrow transplantation therapy.
For this, Mr Koh's 39-year old brother Mr Koh Chuan Hin volunteered to donate his bone marrow and kidney, a gesture that Dr Sivaraman called "humanitarian and selfless".
In the procedure, the patient and donor stem cells blend completely, so that later on, the patient's body does not reject the donor's kidney.
In conventional organ transplantations, patients have to take immunosuppressant medications to stop their body from rejecting the donor's organ. But these medications can have serious side effects, from infections to other organ failures.
Mr Koh Hock Heng had his kidney transplantation in June this year and is not taking any medication. Both he and his brother are healthy and back to leading normal lives.
This is why Dr Sivaraman calls their procedure the "holy grail" in transplantation.
"Ideally, you want to achieve 100 per cent donor tolerance so that the need to take lifelong medication or subsequent organ failure isn't there. We've managed to do this," he said.
Added Associate Professor Chen Chien Shing, Senior Consultant, The Cancer Institute at NUH, "Using this method in future organ transplants is an intensively researched area and there are ongoing protocols for it. We'll review the outcome of what we've achieved to see how it can develop in a year or two."
As it stands, the non-subsidised cost of taking lifelong medication is about $600 a month for 70 per cent of patients who have undergone transplantation. In Singapore, up to 25 kidney transplants take place each year.
Copyright © 2005 MediaCorp Press Ltd.
This article posted December 4, 2005.