Leading Edge Treatments

Pioneering Research that Leads to Leading Edge Treatments

University Hospital Cincinnati Transplant Center is a pioneer in creating transplant discoveries through research that become life-saving treatments for our patients and vastly improve patient care. Our innovative clinical and research initiatives in robotic-assisted surgery and immunosuppressive drugs now offer new hope for patients, especially those in the high-risk category. Our transplant specialists are leaders in minimally invasive nephrectomy (kidney removal), immunosuppressive drug development, cancer and transplantation, steroid elimination, laparoscopic liver surgery, kidney exchange programs and dialysis access research.

Many of these discoveries help remove obstacles to transplantation, decrease the chance of rejection and improve patient outcomes. For instance, by addressing incompatibilities between potential donors and recipients, University Hospital Cincinnati Transplant Center has seen growth in living-donor transplants.

More than 64 percent of University Hospital Cincinnati kidney transplant patients received living-donor transplants, considerably higher than the national average of 45 percent.

Decreasing Patient Sensitization to Increase Chances for Transplant

Each of us has our own immune system which learns what is “self” about our bodies. Sensitization is a natural process in which the immune system recognizes molecules that are not “self.” If you’re exposed to another person’s tissues – perhaps through blood transfusion, kidney transplant or even pregnancy – your immune system recognizes those tissues as “non-self,” immunity is developed and you become sensitized. Antibodies you may have to a potential transplant can be harmful as they can attack the organ and cause rejection. These antibodies and the plasma cells that make them can stay in the body for years. Sensitization is one of the most common reasons patients cannot receive a kidney from a willing donor – for instance, about 25% of patients on the waiting list for kidney transplant have antibodies.

Desensitization is the process of reducing immunity so you may receive a transplant from a donor friend or family member, or increase your chances of being called in from the wait list. Our desensitization treatment program at University Hospital Cincinnati Transplant Center includes the use of innovative therapies that eliminate or lower the presence of antibodies pre-transplant to allow transplant. These therapies also prohibit the development of antibodies post-transplant to reduce longer-term negative effects associated with the new organ.

Developing Individualized, Immunosuppressive Regimens to Reduce Sensitization

University Hospital Cincinnati Transplant Center is developing novel immunosuppressive, individualized regimens, designed to improve long-term survival, and decrease toxicity and side effects.

These leading-edge therapies include FDA-approved chemotherapy drugs, Velcade (bortezomib) and Rituxin (rituximab), traditionally used to treat patients with certain immune cell cancers.

A recent study by University of Cincinnati transplantation researchers presented the results of the use of Velcade in solid organ transplant recipients, demonstrating how the drug is effective in treating rejection episodes caused by antibodies that attack transplanted kidneys.

Our researchers are continuing to examine how the drug may be used in transplantation, including its effect on both late and early acute rejection, and desensitization of patients with high antibody levels pre-transplant. Investigators have found the use of Velcade significantly reduces the level of donor-specific antibodies when prior therapies have failed. They’ve also reported excellent results on Velcade treatment for antibody-mediated rejection. Our specialists now routinely use Velcade to treat antibody-mediated rejection and are receiving nationwide requests for consults.

Our researchers are also examining the use of another process, plasmapheresis — similar to dialysis – to filter the blood to remove antibodies. This process is used to treat rejection, remove antibodies at the time of transplant and for standard desensitization

Our researchers created the START collaborative to share standard of care treatment protocols for Velcade therapies, providing this information to transplant centers worldwide.

Reduced Steroid Therapies for Fewer Cardiovascular Events

Corticosteroids were the first anti-rejection drug used in transplant patients, dating back to the first transplant surgeries over 50 years ago. But our transplant specialists have found that using modern immunosuppressive drugs eliminates the need for steroid therapy as early as seven days following a transplant, while still maintaining kidney function, and reducing associated negative side effects and risk factors.

Corticosteroids are often given to post-transplant patients as part of an immunosuppressive regimen to promote graft survival. But steroids may cause harmful cardiovascular side effects such as increased blood pressure, cholesterol and weight gain.

Recent studies conducted by UC transplantation researchers have shown post-transplant patients who have been removed from a corticosteroid regimen have fewer cardiovascular events and lowered side effects – but with the same graft-function outcomes as patients on steroids. Kidney function was similar in both patient groups – those who received steroids and those who received a placebo.

Just ten years ago, almost 80 percent of post-transplant patients were discharged on steroids. Now, according to the United Network for Organ Sharing (UNOS), less than 20 percent of patients are discharged on steroids while maintaining similar graft outcomes.

Our leading-edge corticosteroid withdrawal therapy has been a successful, standard procedure for our transplant patients for over a decade.

Targeting Tumors with High Dose Radiation

University Hospital Cincinnati Transplant Center is first in the region to introduce TheraSpheres to treat both primary and metastatic liver lesions. TheraSpheres are microscopic glass beads made with a compound that emit high dose radiation energy.

The physician makes a small incision in the leg and places a long, flexible catheter into the femoral artery, the major blood vessel in the leg. Guided by x-ray imaging, the catheter is moved up to the hepatic artery, a blood vessel that feeds the liver. The physician guides the catheter into the branch of the hepatic artery that feeds the cancerous tumor in the liver and infuses the TheraSphere beads into the blood that supplies the tumor. These beads direct precisely-focused doses of radiation exactly at the tumor, meaning less effect on healthy tissue and surrounding organs.

Laparoscopic Kidney Donation

Our surgeons utilize cutting-edge transplantation procedures, such as laparoscopic donor nephrectomy for living kidney donation. A narrow instrument (laparoscope) with a microscopic lens at the end that projects images back to a camera is inserted through tiny incisions, enabling surgeons to remove a kidney from a living donor.

The advantages of laparoscopic surgery are numerous – there’s less trauma in accessing the internal organs and by avoiding a long incision through the muscles, there’s less pain and post-op problems. This procedure increases the willingness to donate, and reduces donor hospital stay and recovery time. Most living kidney donors are eligible for this laparoscopic procedure.