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Thread: Transplant girl's blood change a 'miracle'

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    Transplant girl's blood change a 'miracle'

    SHE'S got purple highlights in her hair and bright blue fingernails, but to doctors at the Children's Hospital at Westmead, Demi-Lee Brennan is a one-in-6 billion miracle.
    The 15-year-old liver transplant patient is the first person in the world to take on the immune system and blood type of her donor, negating the need to take anti-rejection drugs for the rest of her life. The phenomenon, which has been documented in the New England Journal of Medicine, has amazed doctors, who say they have no idea how it occurred.
    Demi-Lee, of Gerroa on the South Coast, was nine when she contracted a virus that destroyed her liver. She was given less than 48 hours to live when a donated liver from a 12-year-old boy became available
    http://www.smh.com.au/news/national/...157559928.html

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    This indeed is a miracle!

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    Quote Originally Posted by Taximom View Post
    This indeed is a miracle!
    I cannot believe her blood type changed. that is incredible. Must get down to stem cells or something.

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    That is a miracle and a huge blessing - stranger than fiction.

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    Absolutely Amazing!

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    Bah I lost the post I was in the middle of writing.

    I had written a lengthy post regarding this supposed article written up in today's NEJM. Suffice it to say that the study was written concerning a 9-yr old liver allograft patient who received the donation from a deceased male infected with CMV. Through immunosuppression she changed from group O, RhD-negative blood to group O, RhD-positive blood which is expected from a engraftment of recipient marrow due to hematopoietic stem cells contained within the transplanted liver.

    Without going into too much detail and boring everyone to death this is not a miracle, its poor journalism at best. The only remarkable thing about this was that a male to female transplantation of diseased tissue was not rejected outright.

    If there is another article coming out of the University of Sydney concerning this topic in this Thursday's NEJM it was not contained in my copy. If someone finds one concerning a 15 yr old girl please forward me the article.

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    Quote Originally Posted by Chloekins View Post
    Bah I lost the post I was in the middle of writing.

    I had written a lengthy post regarding this supposed article written up in today's NEJM. Suffice it to say that the study was written concerning a 9-yr old liver allograft patient who received the donation from a deceased male infected with CMV. Through immunosuppression she changed from group O, RhD-negative blood to group O, RhD-positive blood which is expected from a engraftment of recipient marrow due to hematopoietic stem cells contained within the transplanted liver.

    Without going into too much detail and boring everyone to death this is not a miracle, its poor journalism at best. The only remarkable thing about this was that a male to female transplantation of diseased tissue was not rejected outright.

    If there is another article coming out of the University of Sydney concerning this topic in this Thursday's NEJM it was not contained in my copy. If someone finds one concerning a 15 yr old girl please forward me the article.
    Thank you for your info Chloekins. That makes perfect sense.

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    Are you talking about this article? I read the abstract and I thought that might be what you were talking about. I am having trouble accessing the full text through my University's website but I'll look at it here in a bit.

    Chimerism and Tolerance in a Recipient of a Deceased-Donor Liver Transplant

    http://content.nejm.org/cgi/content/short/358/4/369

    By S.I. Alexander et. al... you guys will probably only be able to see the summary unless you have access it through work, school, or pay for it or you can do the free trial it looks like. :-) But its still nice to read.

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    Quote Originally Posted by pedinurse View Post
    Are you talking about this article? I read the abstract and I thought that might be what you were talking about. I am having trouble accessing the full text through my University's website but I'll look at it here in a bit.

    Chimerism and Tolerance in a Recipient of a Deceased-Donor Liver Transplant

    http://content.nejm.org/cgi/content/short/358/4/369

    By S.I. Alexander et. al... you guys will probably only be able to see the summary unless you have access it through work, school, or pay for it or you can do the free trial it looks like. :-) But its still nice to read.
    Thats the one I found Pedinurse. I read the full article. There were additional articles concerning transplants but one was from a different university involving a different subject protocol and the other involved identical twins.
    If anyone would like the full article let me know and I will send it to you in pdf form.

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    Quote Originally Posted by JBean View Post
    SHE'S got purple highlights in her hair and bright blue fingernails, but to doctors at the Children's Hospital at Westmead, Demi-Lee Brennan is a one-in-6 billion miracle.
    The 15-year-old liver transplant patient is the first person in the world to take on the immune system and blood type of her donor, negating the need to take anti-rejection drugs for the rest of her life. The phenomenon, which has been documented in the New England Journal of Medicine, has amazed doctors, who say they have no idea how it occurred.
    Demi-Lee, of Gerroa on the South Coast, was nine when she contracted a virus that destroyed her liver. She was given less than 48 hours to live when a donated liver from a 12-year-old boy became available
    http://www.smh.com.au/news/national/...157559928.html
    Cool!!! HAPPY DANCE HERE!

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    Quote Originally Posted by Chloekins View Post
    Without going into too much detail and boring everyone to death this is not a miracle, its poor journalism at best. The only remarkable thing about this was that a male to female transplantation of diseased tissue was not rejected outright.

    If there is another article coming out of the University of Sydney concerning this topic in this Thursday's NEJM it was not contained in my copy. If someone finds one concerning a 15 yr old girl please forward me the article.
    My interpretation of the article (which I read after I read your post, Chloekins) is that the phenomenon has been documented in the NEJM, not that the actual girl's case was documented in the NEJM. Look at the way that sentence is phrased. Definitely poor journalism, but not necessarily inaccurate, just VERY misleading.

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    Congratulations to the 15 year old girl, at least she got another chance in life. Hope all goes well for her.

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    Miracles do happen!

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    Quote Originally Posted by JBean View Post
    SHE'S got purple highlights in her hair and bright blue fingernails, but to doctors at the Children's Hospital at Westmead, Demi-Lee Brennan is a one-in-6 billion miracle.
    The 15-year-old liver transplant patient is the first person in the world to take on the immune system and blood type of her donor, negating the need to take anti-rejection drugs for the rest of her life. The phenomenon, which has been documented in the New England Journal of Medicine, has amazed doctors, who say they have no idea how it occurred.
    Demi-Lee, of Gerroa on the South Coast, was nine when she contracted a virus that destroyed her liver. She was given less than 48 hours to live when a donated liver from a 12-year-old boy became available
    http://www.smh.com.au/news/national/...157559928.html
    I have heard of another case similar to this through the transplant grapevine. My husband recently had a liver transplant and is on immune suppressants, though not as many as most patients. Each patient is very different in their medication needs. The patient we heard about was an adult and able to go off the meds completely after 12 years. And they thought that was a miracle!

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    Quote Originally Posted by panglossian View Post
    I have heard of another case similar to this through the transplant grapevine. My husband recently had a liver transplant and is on immune suppressants, though not as many as most patients. Each patient is very different in their medication needs. The patient we heard about was an adult and able to go off the meds completely after 12 years. And they thought that was a miracle!
    Congratulations to your husband on his new liver! So much progress has been made in transplants over the last 10 years. They are better able to match donors to recipients. I believe that is where the true miracles lie. We may not understand something at this moment and it may appear to be an amazing occurrence but give it 10 years and it will be common place.

    I do believe I found the correct article that I mentioned in my original post. The girl was 9 when she contracted a disorder that destroyed her liver hence the requirement for a new one. She received a new liver and over the course of several years has been able to come off of the immunosuppression drugs. From rereading the newspaper article and the NEJM journal submission I believe it is the same case. Too many of the major details remain although most of them have been spun into a fantastic feel good story. This girl has adopted her donors blood type because of stem cells remaining in the donated liver. When her own were wiped out the donors repopulated. It happens frequently in bone marrow transplants. I think the only amazing part of this which made it publication was that she maintained a chiasma status longer than the projected timetable and that this was the first time this particular event occurred after a liver transplant vs a BM transplant.

    There was an additional study that has come out that showed that a complete suppression of patient's immune system and implantation of bone marrow taken from the organ donor actually helped patients (4 out of 5) eventually be able to come off the immunosuppression drugs.
    Last edited by Chloekins; 01-24-2008 at 08:21 PM. Reason: grammar

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    Thank you for your comments. Yes, advances are made rapidly, aren't they?
    They have gone from 12 to 19 hour transplant surgeries to as little as 3 hours.
    I am looking for the article on the patient I mentioned. I know we were excited about the possibilities because it did seem spontaneous, as this girl's was.

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    Quote Originally Posted by Chloekins View Post
    Bah I lost the post I was in the middle of writing.

    I had written a lengthy post regarding this supposed article written up in today's NEJM. Suffice it to say that the study was written concerning a 9-yr old liver allograft patient who received the donation from a deceased male infected with CMV. Through immunosuppression she changed from group O, RhD-negative blood to group O, RhD-positive blood which is expected from a engraftment of recipient marrow due to hematopoietic stem cells contained within the transplanted liver.

    Without going into too much detail and boring everyone to death this is not a miracle, its poor journalism at best. The only remarkable thing about this was that a male to female transplantation of diseased tissue was not rejected outright.

    If there is another article coming out of the University of Sydney concerning this topic in this Thursday's NEJM it was not contained in my copy. If someone finds one concerning a 15 yr old girl please forward me the article.
    Thanks so much for your info. I didn't strike me as a bonafide miracle either. I'm scientifically ignorant, but felt sure there is a scientific reason for what occurred. It is fascinating, though!

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    Well but the fact that she was able to turn over and not have to use suppressants is very impressive - all in 9 months time.

    With BMT patients yes, you get the system of the new patient - that's the whole point. I think that is kind of what throws people off here. This was a SOLID ORGAN TRANSPLANT. But, the liver is a HUGE part of the whole blood system. So...

    In this case, the NEJM says that she had to get re-immunized with her MMR because she took on the immune system of the donor if I remember correctly - she was previously protected, and then she had to get re-vaccinated because post-transplant she was not. I think it is all pretty cool. Her case is apparently out of the norm enough to have it written up in the NEJM. :-)
    But here's the thing - if the POINT isn't to get the patient to take the donor cells and to change blood type (as in BMT)... I mean, this it doesn't strike me that this happens a lot with liver transplants. I sent this article from the NEJM and the newspaper article on to my friend who has worked extensively with children who have had BMT and she said that she found it interesting / cool that by doing a solid organ transplant you can completely transform to donor blood... and I understand that maybe some stem cells are present there in the liver.... but would you need a certain ## of those to allow for this? I guess she had enough of them.

    Pretty crazy or maybe I am just not getting it. But then again, the transplant stuff is always incredibly complex, and it is not my area of concentraton. I definetly think her case is special or it wouldn't have gotten the attention by the NEJM! It's an interesting read... especially the immune system stuff!!!

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    Quote Originally Posted by Shazza View Post
    Congratulations to the 15 year old girl, at least she got another chance in life. Hope all goes well for her.
    Sounds like she was QUITE the sicky when she fell ill. Me too Shazz!!

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    Quote Originally Posted by pedinurse View Post
    Well but the fact that she was able to turn over and not have to use suppressants is very impressive - all in 9 months time.

    With BMT patients yes, you get the system of the new patient - that's the whole point. I think that is kind of what throws people off here. This was a SOLID ORGAN TRANSPLANT. But, the liver is a HUGE part of the whole blood system. So...

    In this case, the NEJM says that she had to get re-immunized with her MMR because she took on the immune system of the donor if I remember correctly - she was previously protected, and then she had to get re-vaccinated because post-transplant she was not. I think it is all pretty cool. Her case is apparently out of the norm enough to have it written up in the NEJM. :-)
    But here's the thing - if the POINT isn't to get the patient to take the donor cells and to change blood type (as in BMT)... I mean, this it doesn't strike me that this happens a lot with liver transplants. I sent this article from the NEJM and the newspaper article on to my friend who has worked extensively with children who have had BMT and she said that she found it interesting / cool that by doing a solid organ transplant you can completely transform to donor blood... and I understand that maybe some stem cells are present there in the liver.... but would you need a certain ## of those to allow for this? I guess she had enough of them.

    Pretty crazy or maybe I am just not getting it. But then again, the transplant stuff is always incredibly complex, and it is not my area of concentraton. I definetly think her case is special or it wouldn't have gotten the attention by the NEJM! It's an interesting read... especially the immune system stuff!!!
    I agree it is pretty cool. I wouldn't go as far as to call it a miracle by any means. We work quite often BMT patients as we have a very large leukemia/lymphoma population at our hospital. Since the liver has a large portion of hematopoietic stem cells present naturally in residence it stands to reason that the complete suppression of her own immune system would allow for these hematopoietic blasts to repopulate. I think its fantastic and means a great deal for the medical community. I hope this doesn't prove to be a single shot in the dark.

    If you read the other article in the journal concerning the study done with 5 people they did much the same with these patients as with the girl but with a slight variation. They completely suppressed the recipients immune system and transplanted BM from the same person their new organ was coming from. They found that in 4 out of 5 patients they were able to be weaned off the immunosuppression drugs eventually. That in my mind is even more overwhelming than the one case we are focusing on here. This could open up all sorts of progress.

    I think its prudent to note that there is a portion of the transplant population that take themselves off their drugs and discontinue follow-up yearly exams. Some of them die but a surprising amount live. There is one case in particular that I know of directly where the gentleman had a full liver transplant and removed himself from his drug regimen after only 3 years. He lived. Now I definitely would have advised him against this move as I would have thought it would kill him. I was wrong in his particular case.

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    I work for a pharm company that makes transplant drugs...I do not think this is a miracle (unexplained) but none the less is miraculous.

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    http://news.yahoo.com/s/afp/20080124...drentransplant

    this is a yahoo article I saw - didn't really explain a whole lot different but did quote a doc treating that noted the stem cell role in her case.

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