LCFC#8: Making progress, but never fast enough
Plus: The technicalities of transplant
“Experience has taught us that managing the immune response is like peeling back layers of an onion.” Reading that line by Roger M. Mills in a response to Amy Silverstein’s essay about her two heart transplants, which I wrote about two weeks ago, has helped me to understand Silverstein’s criticism of immunosuppressant drugs and why progress has been slow to improve them.
According to Mills, a former medical director for cardiac transplantation at the University of Florida, scientists and doctors thought the immune system would be easier to tame. But as he and others have learned, “there are more layers than we ever dreamed of, and each one brings more tears.”
Because of the complexity of layers, it’s not likely immunosuppressant drugs will change soon, my doctor told me at my 6-month check up. I asked him about Silverstein’s essay, which he said had been circulating among the heart doctors at Duke. He did say he hoped the essay would galvanize the research community to find better alternatives, and he did remind me that he currently works with lots of people who have had their transplanted hearts for 30 years or more. That put my mind at ease, a bit. He also reminded me that the doses of immunosuppressive drugs are lower now than they were in the 1980s when heart transplantation took off. (Here’s a little history, but I will warn you, there are graphic heart photos in that article).
Doctors also have better tools to look for signs of rejection and spot it earlier. My doctor gave me a look ahead to the next few months and said that if all goes well, we’d get to a place where I wouldn’t need to come in and have a team numb my neck, insert a catheter into a blood vessel, thread it to my heart and tickle it to take a few small clumps to make sure my immune system isn’t attacking the healthy new organ, what’s called rejection.
I will note that the procedure is by no means a tickle. I’ve decided it’s more like a pinch, one that takes cells with it. But I can see how telling people you’re going to pinch their hearts versus tickle them could raise alarm. As nerve-racking as those procedures are, I am excited that progress is being made to create blood tests sensitive enough to look for signs of rejection and that I may not have to have my heart pinched multiple times a year in the months ahead. (I had it done once a week, then every other week, then once a month for the past six months. Now, I’ve graduated to every other month.)
The blood biomarker for rejection is progress. There’s experimentation with transplanting pig hearts to have access to more organs, too. (I get asked a lot, so I will say right here I received a human heart). Beyond hearts, there’s recently been uterus transplants, which have led to the birth of babies. And soon doctors will attempt the first bladder transplant, made challenging by the complexity of the blood vessel tracts in the pelvic region. The network of blood vessels is so complex the doctors will use a robot to make smaller, more precise incisions during the surgery.
It strikes me as odd that doctors would have figured out how to do a heart transplant long before transplanting a bladder. But that’s the body for you; it’s always going to have layers we will continually need to peel back to move forward.