Teen Takes On Donor's Immune System

Leibel writes "The Australian ABC News is reporting that a 15-year-old Australian liver transplant patient has defied modern medicine by taking on her donor's immune system. Demi-Lee Brennan had a liver transplant. Nine months later, doctors at Sydney's Westmead Children's Hospital were amazed to find the teenager's blood group had changed to the donor's blood type. They were even more surprised when they found the girl's immune system had almost totally been replaced by that of the donor, meaning she no longer had to take anti-rejection drugs. 'Dr. Michael Stormon says his team is now trying to identify how the phenomenon happened and whether it can be replicated. "That's probably easier said than done... I think it's a long shot," he said. "I think it's a unique system of events whereby this happened. "We postulate there's a number of different issues - the type of liver failure that she had, some of the drugs that we use early on to suppress the immune system and also that she suffered an infection with a virus called CMV, or cytomegalovirus, which can also suppress the immune system."'"

Comments

But what about her OEM parts?

[kindbud]

Wouldn't her new immune system see the rest of her body apart from the liver as a foreign invader, and attack it?

Re:Self-rejection?

[AgentPaper]

That was precisely my thought - where exactly does this differ from GVH? Any time you have a mismatch between HLA haplotypes on immune cells and other tissue cells, you're going to have an immune reaction, regardless of whose immune cells initiate it. It's rather unique that this occurred in the context of a solid organ transplant - you usually see it with bone marrow - but the underlying process doesn't look any different.

Of course, ABC News isn't exactly a peer-reviewed journal, so I'll reserve full analysis for such time as this patient is written up in the literature, but I'm not seeing anything outside the realms of modern medicine here.

Re:Sounds like malpractice.

[NIckGorton]

Is it normal to transplant livers across blood types? You can accept an Rh mismatch for a liver transplantation. And if you are going to die tomorrow, death from rejection in 5 years is a better deal.

This sounds like a nearly missed case of malpractice. No. First of all this was not in the US. It is a uniquely American thing to assume that unless 1) All care is 100% perfect and 2) The outcome is 100% perfect, that you should sue your physician for malpractice.

Despite the best care, sometimes bad things happen and people die. And sometimes the best care isn't possible, and you do the best you can as the doctors did in this case. The ideal is a perfect blood type and HLA match, however failing to act because you don't have a perfect match would have resulted in this child's death. Perfect in this case is the enemy of good.

Unfortunately this sort of attitude creates no end to trouble and causes both inappropriately aggressive therapeutics and diagnostics in the US as opposed to elsewhere. There is a saying amongst OB/Gyns - you don't get sued for the C-Section that you do, you get sued for the C-Section you don't do. So surprise.... the US has a higher section rate for women. Similarly, in the US your child with belly pain is much more likely to get a CT scan to rule out appendicitis. Doing the CT doesn't get you sued, but failing to do it eventually will (because there is always going to be that very small number of kids with an appy that presented very atypically.) However, if you do 500 Abdominal CTs in kids less than 15, you will ultimately cause one excess cancer death in that group. But you won't get sued when the kid dies of renal cell cancer in his 40's. So kids with a very low risk of appendicitis instead of being observed (maybe even at home with responsible parents) will more often in the US get a trip to the donut and the resulting dose of radiation to their more vulnerable bodies.

While it might seem that holding physicians to unreasonable expectations is beneficial, in the long run you will get worse care due to the practice of defensive medicine.