For 12 years, this is the routine that Pete Giannaris has had to accept, kidney dialysis three times a week. As vital as it is, he admits it can wear a guy down.
Pete Giannaris: I mean, even myself, I knew that, man, you know. It has taken a toll on my body.
Pete has dealt with kidney disease most of his life. Even receiving kidney transplants before, but this time was different. He was told he would almost certainly reject any donor organ.
Pete Giannaris: Not many people understand. Oh, you need a kidney. You get on the list. Two years later, you get your kidney and your fine. You know, it's not the story for everybody.
Mark Stegall, M.D. — Mayo Clinic transplant surgeon: About 80 percent of people who have had a previous transplant have antibodies against other tissue types. They also could have been exposed to foreign tissue types by a blood transfusion or even pregnancy.
Anissa Swanigan: I was devastated. Shocked. Didn't really see it coming.
Pregnancy delivered a double-blow to Anissa Swanigan. After giving birth a second time, her weakened heart condition advanced to heart failure and complications scarred her liver so badly it was failing too. Doctors told her she needed a double organ transplant.
Anissa Swanigan: It was the only way you're going to survive.
She had two big reasons to survive. Her two little boys. But, again, high levels of antibodies made her a very poor transplant candidate. Antibodies are a good thing when they help us fight disease. Vaccines, for example, trigger our immune systems to create antibodies. But for some of those waiting to receive life-saving organs, Mayo Clinic transplant surgeon and immunology researcher, Mark Stegall says, antibodies become the enemy.
Mark Stegall, M.D.: It's a big problem. There are about 9,000 people on the kidney transplant list in the United States right now who have really high levels of antibody to the point that they can't really get a transplant.
Pete is in that category, called highly sensitized. So Dr. Stegall and his team did a variety of things in advance to tip the odds in his favor. They carefully selected a living donor for which Pete would have the fewest antibodies. Also, drug researchers found a way to reduce antibody-caused rejection rates from 40% to less than 10%.
Mark Stegall, M.D.: One of the drugs that we were the first to use is a drug called eculizumab. If we give this drug, the antibody binds to the kidney but it doesn't cause the damage.
Pete had also gone through a number of rounds of an antibody filtering process called a plasma exchange. Then, to try to halt the production of new antibodies in his bone marrow, Dr. Stegall turned to an FDA-approved clinical trial at Mayo Clinic using a powerful drug.
Mark Stegall, M.D.: A drug called valcade which is actually used in the treatment of cancers of these antibody-secreting cells. But, of course, these are not cancer cells, these are normal cells.
Anissa also underwent drug and plasma exchange therapies, but her antibody levels were still so high doctors worried that her body might still reject the donor organs.
Richard Daly, M.D. — Mayo Clinic transplant surgeon: By the time the liver went in, the heart might already be irreversibly damaged by the antibodies. So we reversed the process and did the liver transplant first.
Why?
Surgical Director of Heart and Lung Transplantation at Mayo Clinic, Dr. Richard Daly, says the liver filters antibodies. In combined kidney-liver or heart-liver transplants, his team had observed a reduction in antibodies to that donor. However, in multiple organ transplants, hearts generally have to go in first because their tissues are more time sensitive. How does the Mayo team get around that?
Richard Daly, M.D.: Choreograph the whole process. We have to have the donor close enough by. We have to have the procurement done and be really completely ready for the organs when they arrive.
Anissa Swanigan: It seemed brilliant. Brilliant minds that they collaborated and they got together and figured out how to do this thing.
Pete Giannaris: I took a chance. I didn't have anything to lose. So either I stay on dialysis or a miracle happens and I get this kidney.
Innovation that makes a world of difference, one patient at a time.