Renowned transplant surgeon Dr. Robert Montgomery warns that long-term survival depends on safer immunosuppressants and stronger antiviral defenses.
Robert Montgomery, M.D., Ph.D.
Director, Transplant Institute, NYU Langone Health
Why are kidney transplant patients more vulnerable to infections like COVID-19?
Kidney patients tend to be on more intense long-term maintenance immunosuppression drugs than other organ transplants, and this can affect their response to vaccines. Many will not develop neutralizing antibodies like non-immunosuppressed individuals, reducing their immunity to viruses like COVID-19 and increasing the severity and length of illness when they have a COVID-19 infection.
How does having a weakened immune system impact transplant patients in their day-to-day lives and long-term health?
People who are on immunosuppressive therapy, which is required for all organ transplants, are more likely to become infected with COVID-19, the resulting illness tends to be more severe and last longer, and they tend to shed the virus for longer periods of time. Immunosuppression makes any virally driven diseases — including certain cancers — and infectious diseases in general more likely. Cancers and infections become a major long-term threat to their health.
What kinds of medical innovations are most needed to better protect immunocompromised patients?
More effective preventive, prophylactic drugs and more potent treatments (when they become infected) are most needed. We need new immunosuppressive drugs that have less toxicity and are more narrow in terms of activity — less permissive in terms of increasing susceptibility to infections and cancers, but still effective for preventing rejection. Also, we need approaches that create “tolerance” in which the organ is accepted and not attacked by the recipient’s immune system, and there is no need for immunosuppression.
How do you see advances in infection prevention and treatment shaping the future of transplant care?
Organ transplantation has become highly effective in short-term survival (one to three years) but has not shown the same progress in terms of long-term survival (five to 10 years). The immunosuppressive drugs have lots of side effects, many of which patients feel are intolerable or life-threatening in the long term. They also have toxicities (causing kidney failure) and increase the likelihood of serious infections and cancers.
