Tag Archives: Transplant

A vision of kiwi kidneys

Sick of writing boring text reports.  Take a leaf out of Christchurch nephrologist Dr Suetonia Palmer’s (@SuetoniaPalmer) book and make a visual abstract report.  Here are two she has created recently based on data collected about organ donation and end stage renal failure by ANZDATA (@ANZDATARegistry). Enjoy.

Suetonia C-18RfJXUAApRcU

Suetonia C-16lBZXsAERoeM

ps. The featured image is of the Kidney Brothers.  Check out the great educational resources at The OrganWiseGuys.

Cheesecake files: A little something for World Kidney Day

Today is World Kidney Day, so I shall let you in on a little secret. There is a new tool for predicting if a transplant is going to be problematic to get working properly.

Nephrologist call a transplant a “graft” and when the new kidney is not really filtering as well as hoped after a week they call it “Delayed Graft Function.”  Rather than waiting a week, the nephrologist would like to know in the first few hours after the transplant if the new kidney is going to be one of these “problematic” transplants or not.  A lot of money has been spent on developing some fancy new biomarkers (urinary) and they may well have their place.  At this stage none are terribly good at predicting delayed graft function.

A while ago I helped develop a new tool – simply the ratio of  a measurement of the rate at which a particular substance is being peed out of the body  to an estimate how much the body is is producing in the first place.  If the ratio is 1 then the kidney is in a steady state. If not, then either the kidneys are not performing well (ie not keeping up with the production), or they have improved enough after a problem and are getting rid of the “excess” of the substance from the body.  This ratio is simple and easy to calculate and doesn’t require extra expense or specialist equipment.

A few months ago, I persuaded a colleague in Australia to check if this ratio could be used soon after transplant to predict delayed graft function. As it turns out in the small study we ran that it can, and that it adds value to a risk prediction model based on the normal stuff nephrologists measure! I’m quite chuffed about this.  Sometimes, the simple works.  Maybe something will become of it and ultimately some transplants will work better and others will not fail.  Anyway, it’s nice to bring a measure of hope on World Kidney Day.

This was published a couple of weeks ago in the journal Nephron.

 

A taste of success

Some recent successes of University of Otago Christchurch researchers:

Chlorine bleach key in disease?

Professor Tony Kettle from the Centre for Free Radical Research has won a prestigious Marsden Fund grant to better understand a ‘Jekyll and Hyde’ chemical with a role in heart disease, cancer, cystic fibrosis, and rheumatoid arthritis.

Professor Kettle will investigate chlorine bleach’s role in strengthening collagen by linking to form a resilient mesh. Without this mesh people can develop cataracts and an autoimmune disease that destroys the kidneys and causes the lungs to hemorrhage. However bleach can also have negative effects.

“Chlorine bleach should be viewed as a natural chemical with a Jekyll and Hyde personality. It helps us to fight infections and form strong connective tissue but also endangers our health during uncontrolled inflammation.”

Professor Kettle and his team will work with researchers from Vienna and Budapest on the project.

Improving the treatment and experience for dialysis patients

Chronic kidney disease is common, affecting about 500,000 New Zealanders. It is important because it increases chances of heart disease and death and may lead to needing treatment with dialysis or a kidney transplant. Dialysis therapy is a heavy and costly burden for patients and their families and the health system. However, there is a lack of reliable evidence to improve patient outcomes.

Dr Suetonia Palmer has just been awarded a prestigious Rutherford Discovery Fellowship valued at $800,000 over five years for research project called: “Improving evidence for decision-makers in chronic kidney disease.”

Dr Palmer’s research aims to to provide rigorous overviews of existing research and participant-led enquiry to provide better and more useable information for clinicians, consumers and policy-makers in the field of chronic kidney disease.

Recovering from food addiction

Professor Doug Sellman and his team from the National Addiction Centre have just been granted funding to trial a new treatment for those with obesity called Kia Akina.

“There is a serious need to develop new non-surgical ways of treating obesity because obesity-related diseases are expensive for New Zealand, traditional non-surgical methods are not working, and surgery is very costly,” says Professor Sellman.

Kia Akina uses a ‘food addiction’ approach to obesity. Professor Sellman says the project will test the feasibility, short-term effectiveness and participant satisfaction ofKia Akina within a primary health care setting.

If shown to be effective, Kia Akina will be developed as a non-commercial, low cost network for obesity recovery throughout New Zealand.

Innovation in Indigenous Health

Christchurch’s Maori/Indigenous Health Institute (MIHI) recently won the Australasian award for ‘innovation in Indigenous health curriculum implementation’ at the Leaders in Indigenous Medical Education (LIME) conference.

The LIME conference brings together all 20 medical schools throughout Australia and New Zealand, and hosts attendees from the United States and Canada.

Staff and students of the University of Otago, Christchurch, in Darwin at the Leaders in Indigenous Medical Education (LIME) conference

Staff and students of the University of Otago, Christchurch, in Darwin at the Leaders in Indigenous Medical Education (LIME) conference

MIHI director Suzanne Pitama says she and her team were thrilled to receive the award. As there is much collaboration between indigenous teaching teams at University of Otago’s Christchurch, Wellington and Dunedin campuses, the award recognises the innovation of all these teams.  It also recognised the systemic support within the University of Otago to prioritise indigenous health within the curriculum.

MIHI oversees the Maori health component of the medical curriculum at the University of Otago, Christchurch.

Award nominees are judged on how well their teaching programmes demonstrate their commitment and experience to understanding and furthering the health of Maori and Indigenous peoples.

The award has been presented for four years, says Pitama. MIHI also won it in the inaugural year.

A review panel of academic peers and members of indigenous medical doctors associations judge the award, Pitama says.

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This guest post was written by Kim Thomas,  Senior Communications Advisor, University of Otago, Christchurch, www.uoc.otago.ac.nz.

Cooking up a new kidney

The Boston Kidney Recipe

  1. Take an unwanted kidney.
  2. Disconnect from plumbing.
  3. Wash away cells (use plenty of detergent).
  4. Take resultant scaffold and reseed with a few cells obtained from someone needing the kidney.
  5. Place in bioreactor and “cook” for 3 to 5d (or until done)
  6. Place regenerated kidneys into the transplant recipient and connect to plumbing.
  7. Pee.

In Nature Medicine today Massachusetts General Hospital based researchers have announced the successful removal of an unwanted kidney from one rat, the removal of cells from that kidney, regeneration with stem cells from another rat, transplantation into that animal and the observation of  urine production*.  A  small step for a rat, a giant leap for anyone waiting for a transplant.  Why is this so important?  As the authors’ state:

“A bioengineered kidney derived from patient-derived cells and regenerated ‘on demand’ for transplantation could provide an alternative treatment for patients suffering from renal failure.”

While this study is “proof of context”, it is a beautiful proof and one which should bring hope to millions. There are many more people with End Stage Renal Disease than kidneys available for transplant.  Some donated kidneys currently considered not good for transplant may become viable in the future if the cells are stripped off and the patient’s own stem cells can be used to grow a new kidney over the scaffold of the old one.  By using the patient’s own cells the immune response may be reduced.  This will mean less dependence of immunosuppressant drugs and therefore fewer side effects, including  cancer, and less transplant rejection. This is the vision and one that can not come soon enough.  Have a look at the video and if you want to get into details, check out the paper* .

*Regeneration and experimental orthotopic transplantation of a bioengineered kidney. Jeremy J Song, Jacques P Guyette, Sarah E Gilpin, Gabriel Gonzalez, Joseph P Vacanti & Harald C Ott1. Nature Medicine. Advance Publication Online. http://dx.doi.org/10.1038/nm.3154