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Tag: transplant surgery

  • Nurse becomes a living organ donor for her mom — twice | CNN

    Nurse becomes a living organ donor for her mom — twice | CNN

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    CNN
     — 

    Marzena Stasieluk needed a new kidney. She’d been diagnosed with kidney disease in 2015, and ultimately needed dialysis, a grueling process where a machine did the work her kidneys could no longer do.

    But in order for a kidney transplant to succeed, she needed a liver first. Stasieluk’s liver disease had been controlled for more than a decade, but it worsened during the Covid-19 pandemic. It wasn’t so bad that she would be prioritized for a liver from a deceased donor, her family said, but bad enough that a kidney transplant likely wouldn’t work.

    Marzena’s daughter, Jennifer Stasieluk, is a nurse who has cared for patients in the hardest of times, through Covid-19 and cancer. She was willing, even eager, to give her mother a kidney. They’d done all the scans and test, but it wasn’t going to work.

    Although they had the same blood type, her mother is among a subset of patients called “highly sensitized.” Marzena had a high number of antibodies against foreign tissues – a factor that increases the likelihood an organ will be rejected and makes it much harder to find a match.

    “She needed a new liver to do a kidney transplant. However, her liver by itself wasn’t sick enough,” recalls Jennifer, 29. “So, they kind of, like, threw their hands up and were just, kind of, like, ‘sorry.’ ”

    In January 2020, an appointment with Mayo Clinic in Rochester, Minnesota, introduced a new idea: Doctors suggested Marzena get a portion of a liver from a living donor.

    Jennifer insisted she get tested. Despite her mother’s protests, she wouldn’t take no for an answer. And this time, the response was a good one.

    “I kicked her door open in the morning when I got that call that I was a match. I said ‘Mom, I’m a match, pack your bags, surgery’s in six weeks.’ We couldn’t believe I was a match,” Jennifer said.

    On June 25, 2021, Jennifer gave her mother a lobe of her liver. Jennifer spent five days recovering in the hospital, and Marzena spent 11. For living donors and recipients, the liver has the unique ability to regenerate in a matter of weeks, and recovery was successful for mother and daughter.

    But Marzena, affectionately known as a “professional grandma,” had to continue with dialysis, and was desperate for a normal life.

    “It was awful. You sit there three days a week for over three hours,” said Marzena, who lives in Illinois. “My kids and my grandkids are the whole world and that’s why I was fighting for so long. I don’t want them, the kids and my grandkids, to lose me.”

    After the liver transplant, Jennifer was prepared to donate a kidney to a stranger as part of a paired donation – a process in which living donor’s kidneys are swapped so recipients like Marzena receive a compatible organ.

    Jennifer went through another round of bloodwork and tests to prepare for kidney donation. But then came a surprise: Because of the effect Jennifer’s liver had on her mother’s immune system, she was now able to give her mother a kidney.

    “We never in a million years thought that I would be a direct match,” Jennifer said. “I was excited for it. I wasn’t nervous. I knew I was in good hands.

    “I gave her the bigger lobe of my liver on June 25, 2021. And then a year later, a kidney.”

    Jennifer Stasieluk, left, and her mother Marzena Stasieluk.

    Dr. Timucin Taner, division chair of transplant surgery at the Mayo Clinic in Minnesota, performed the liver transplant for the Stasieluks.

    He and his colleagues have been studying the effect of liver transplants on the immune system, including research into how a liver transplant before a heart transplant – not the typical order – can reduce organ rejection.

    Taner said the Stasieluks are the first case they’re aware of where a liver’s effect on a patient’s immune response allowed for a subsequent kidney transplant from the same donor. They’re planning to write a case report about the procedures.

    “She donated two organs a year apart to the same person,” Taner said of Jennifer. “So she saved her mom’s life twice.”

    Taner says organ donors, living or deceased, are heroes. There simply aren’t enough organs to provide for everyone who needs one.

    Across the country, nearly 106,000 people are on the national transplant waiting list according to the United Network for Organ Sharing. So far this year, nearly 40,000 transplants have been performed.

    “On average, typically about 25,000 people in the U.S. are waiting for a liver transplant on the waiting list,” Taner said. “And of those, every year we can only transplant up to about 9,000 of them because that’s only how many livers we have.

    Jennifer described working long, late shifts as a nurse helping patients and their families during the height of the pandemic. There were dark days when answers were few and hope was sometimes hard to come by.

    “Losing patients to Covid was devastating. I felt so helpless,” Jennifer said.

    But donating organs to her mother – twice – was empowering.

    “Just knowing that there is something I can do that is not hopeless … just having that power that I can actually do something and help her and save her life, it was amazing,” Jennifer said.

    This will be the first Christmas in about seven years when Marzena is feeling healthy. Jennifer said it’s more special than any holiday before.

    Marzena said her daughter’s gifts changed her life.

    “Today, I am grateful. I don’t think I’ll ever be able to say enough, thank you,” Marzena said, fighting back tears. “What do you say to a person that donated two organs, not just one?”

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  • Vitiligo: Treatment Options and Innovations

    Vitiligo: Treatment Options and Innovations

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    By Bassel H. Mahmoud, MD, PhD, as told to Susan Bernstein

    Vitiligo is mainly an autoimmune disease of the skin that targets pigment-producing cells called melanocytes. This results in patches of depigmentation in the form of chalky white areas on the skin that can range from very small to very large, even covering most of the skin surface.

    Vitiligo affects anywhere from 0.5% to 2% of the population, both adults and children, and affects people of all ethnic groups and all skin types. Vitiligo, although most of the time considered a cosmetic problem, can have a devastating psychological effect on patients and can affect their quality of life.

    Treatments for vitiligo include topical and systemic immunosuppressant medications. The one that may be best for you depends on how extensive and active your disease is. There is also phototherapy, which uses ultraviolet light and laser. Other options include surgical treatment.

    Immune T cells Attack Pigment Cells

    Recent research studies have looked at the pathogenesis of vitiligo, which simply means the chain of events leading to this disease. These studies showed that vitiligo is an interferon-gamma driven disease leading to recruitment of CD8-positive T cells. These are cytotoxic T cells that engage with the melanocytes, or cells producing pigment in the skin, and kill them. Now that we have a better idea of how vitiligo occurs, we can develop better treatments to address this process. These newer treatments target and block these chains of events.

    Recently developed drugs for vitiligo that have shown promising results are Janus

    kinase (JAK) inhibitors. Examples include ruxolitinib and tofacitinib. Both are immune-suppressing medications that disrupt the cytokine signaling in the interferon-gamma pathway. Some of these new medicines can be used at topic creams or taken by mouth. It does take a few months to start seeing repigmentation of the vitiligo skin.

    Many conventional treatments are still used and can be effective for vitiligo, such as oral and topical corticosteroids, which can have side effects if taken for a longer period of time, even topical steroids. The main side effect of topical steroids is skin atrophy, thinning of the skin. Calcineurin inhibitors, such as tacrolimus, are nonsteroidal alternative topical treatments, and they do not have the risk of skin thinning.

    Light and Laser Treatments

    Phototherapy is also a common, conventional treatment for vitiligo. The most used is narrow-band ultraviolet B light. It’s effective and relatively safe when used under supervision of a board-certified dermatologist. Another type of phototherapy is called PUVA, which is still used in some countries, but studies show that if it’s used for too long, it can cause skin cancer.

    Previously, phototherapy treatments were done only at the dermatologist’s office two to three times a week. While it only takes a few seconds to a few minutes to get the treatment, you would still have to leave your work or school to come to your doctor’s office. Now, there are home phototherapy devices available, including many that are covered by insurance with a dermatologist’s prescription.

    There is also a laser treatment for vitiligo called excimer laser. You must go to your doctor’s office for this treatment. A machine is used to target the vitiligo areas of the skin with an excimer laser. This treatment is in the ultraviolet range, but it’s a laser, not light. It’s stronger and can have a good effect on the areas that do not respond to treatment with UV light. You need to get the treatment two to three times a week.

    New Cell and Tissue Transplant Surgeries

    Cell transplant surgery is an option for recalcitrant vitiligo, which means when your vitiligo patches fail to respond to other conventional medications or light therapies. There are very few places in the U.S. that offer this surgery; one of them is at our department of dermatology at the University of Massachusetts. In vitiligo, there is a loss of the melanocytes in your skin, but the hair follicles in this area may have it and act as a reservoir of melanocytes. But if the hair also becomes white, then the reservoir of melanocytes is lost, and this vitiligo area will not respond to conventional therapy, and this is when a cell transplant procedure would yield the best outcome.

    One type of surgical treatment is tissue transplant, such as punch grafting from normal skin and applying it to the vitiligo area. But the surface area to treat with this type of transplant is very limited. Also, the outcome is not optimum as it can cause a “cobblestone” look, which may be cosmetically unacceptable.

    The other type of surgical option, which is the one I perform, is a cell transplant technique. We take a small amount of normal skin from a donor area, usually a hidden area on the body such as the upper thigh or buttock. Then, we extract the melanocytes from it and suspend them in a solution. While doing this step, we use a laser to resurface the vitiligo areas. Then, when the cells are ready, we apply them to the vitiligo patches and cover them with a bandage. This technique only requires a small area of skin to be taken from the donor site to cover a much larger area of vitiligo, which is a major advantage. The outcome leads to homogenous repigmentation without the cobblestone effect. The procedure is all done under local anesthesia as an outpatient procedure. The complications are minimal with excellent outcomes.

    Talk About Your Options

    When a patient with vitiligo comes into our office, they are counseled regarding the nature of their condition, different treatment options, techniques, and complications in detail. Then we come up with the best treatment plan for you. There are also many resources to help you understand vitiligo and treatment options that can be found on the American Academy of Dermatology’s website, so please visit www.aad.org for more information on skin, hair, and nail health, and www.umassmed.edu/vitiligo/ for our Vitiligo Clinic and Research Center at UMass.

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