Two-Edged sword

Drugs that aid transplantation eventually can harm kidneys

Dave Parks

News staff writer

December 11, 2006

Sam Fitts received a life-saving heart transplant 18 years ago at UAB, and came away from the experience with what seemed like a minor trade-off. All he had to do was take drugs for the rest of his life to keep his body from rejecting the organ.

"The heart's doing fine," Fitts, a Baptist minister from Elberta in Baldwin County, said recently.

Unfortunately, his kidneys aren't. The anti-rejection drugs have taken their toll on those organs, and now at age 64 Fitts needs another transplant, this time a kidney.

His experience isn't unusual. The discovery of immunosuppressive drugs like cyclosporin and Prograf have revolutionized organ transplantation, but the drugs have a double edge. While they clearly have extended the lives of thousands of patients, studies have shown that they often destroy kidney function.

It's a big risk for transplant patients. A recent study of 70,000 of patients who received hearts, lungs, livers or intestines found that three years after transplant about 15 percent of them had signs of chronic kidney disease.

Dr. Mark Deirhoi, director of the kidney transplant program at the University of Alabama at Birmingham, said this type of drug toxicity is a growing problem just because of the increasing numbers of patients who have received transplants.

When Fitts received his heart in 1988, he was among 12,618 Americans who got an organ transplant of any type that year. Last year, 28,107 organs were transplanted in the United States, an increase of more than 200 percent, according to the United Network for Organ Sharing. Since 1988, U.S. doctors have performed a total of 384,256 organ transplants.

Deirhoi said about 10 percent of patients with transplants other than kidneys end up needing kidney transplants because of anti-rejection drug toxicity. The problem also affects patients with kidney transplants, but that's difficult to quantify since it's hard to tell whether a kidney failed because of anti-rejection drugs or because of a patient's body rejecting it.

Anti-rejection drugs damage kidneys by lowering blood flow to them, which appears to cause scarring. Eventually, the organ can lose its ability to filter out the body's wastes. The process usually takes 10 to 12 years, Deirhoi said.

Once kidney failure occurs in transplant patients, they have fewer options for survival than other kidney patients since they aren't good candidates for dialysis. That's because renal failure itself weakens the immune system, and the anti-rejection drugs exacerbate that problem. The result is a patient who is extremely susceptible to infections, a constant risk poised by dialysis.

"In the long term they do badly if they have to be on dialysis for an extended period of time," Deirhoi said.

Ideally, they do much better if they get a kidney before needing dialysis. That's another problem. The waiting times for a donor kidney is now five or six years, Deirhoi said. Eventually doctors hope to find better methods of keeping transplant patients from rejecting organs. Research is under way, but it will likely be years before the problem is solved.

So for now, Fitts' best chance for survival is finding a living donor who is willing to provide a kidney.

A couple of weeks ago he thought he had one. A friend, Shirley Pitts, of Pace, Fla., offered one of her kidneys. Fitts is minister of education at Immanuel Baptist Church in Pace, and Pitts is a member of the congregation there.

Pitts said she heard Fitts talking about his heart transplant and was impressed with his positive attitude about life. So donating a kidney just seemed like the right thing to do.

"I just feel like this is something God wants me to do because just the way Sam lives. And God gave me a good, healthy life. I got a good body and a healthy body. And I thought I'll give back."

She went through all the screening and came to Birmingham recently for the operation. Unfortunately, last-minute testing showed that the donation wouldn't work because of incompatible antibodies, and the operation was canceled

Fitts was disappointed but accepted the outcome. He will continue his search for a donor, he said.

"God's got a plan," he said. "I'm fine."

Copyright © 2006 The Birmingham News.

This article posted December 25, 2006.