Newborns May Have More Choices for Organ Transplants

Young immune systems might not reject organs, even when not a perfect match

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For patients with end stage organ failure, finding a donor for an organ transplant can be the difference between life and death. However, we face persistent shortages in available organs for patients who need them. On top of this, even when an organ is available, it may not be a match for a potential recipient.

A patient’s immune system is always hunting for foreign material, such as bacteria, that might cause illness by responding to markers called antigens to recognize items as “self” or “foreign” – blood type is one example of this. As a result, a donor organ can also be rejected as foreign. Even with excellent matches, patients with organ transplants have to be medicated for life to suppress the immune reaction to the organ, which also leaves them vulnerable to infections and other complications.

Dr. Lori West, pediatric cardiologist at the University of Alberta and the Director of the Canadian National Transplant Research Program (CNTRP), is looking for ways to teach the immune system to stay active without rejecting an organ transplant. Her work with the CNTRP brings together an interdisciplinary team of 120 researchers from across Canada to tackle issues related to organ transplantation.

West is both a researcher and a clinician, working directly with children who need organ transplants. Even before birth, we can now diagnose children with heart malformations that will require heart transplants. Although it was initially thought that transplanting organs in newborn children would be a higher risk procedure than in adults, the opposite has turned out to be true.

“In a very young immune system, instead of mounting an active auto-immune response to antigens that it encounters, it’s susceptible to what we call tolerance and it turns off that immune response rather than turning on. This is precisely what we need,” explains West.

In fact, even organs that are mismatched for blood type can be safe when transplanted soon after birth – the early exposure to the blood antigens allows the body to tolerate the transplant. If we can trigger the same response in adult patients, then this may help solve many of our current limitations.

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Dr. Lori West is a Professor of Pediatrics, Surgery and Immunology at the University of Alberta and serves as Interim Director and Research Director of the Alberta Transplant Institute. She holds a Tier 1 Canada Research Chair in Cardiac Transplantation. She is a world leader in pediatric heart transplantation and transplant immunobiology, including crucial translation of basic concepts and findings from animal models to clinical application in organ transplantation. Her work resulted in a pioneering strategy for increasing donor availability for infants by crossing the ABO barrier, which has had a major global impact on infant heart transplantation. Her investigations of immune development of infants after ABO-mismatched transplantation led to the first demonstration of neonatal transplant tolerance in humans. Dr. West is the founding Director of the Canadian National Transplant Research Program (CNTRP), a newly created coalition of more than 100 investigators at 22 sites across Canada funded by CIHR and partners with the overarching goals of increasing access of Canadians to transplantation and improving long-term transplant outcomes.