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Surgeon takes part in study to help kidney transplant patients

A transplant surgeon at Scripps Green Hospital was part of a team of researchers that published a study in a prestigious medical journal earlier this year, which shows promise for helping kidney transplant patients avoid complications due to organ rejection.

Dr. Christopher Marsh, a Rancho Santa Fe resident who has been with Scripps for about 15 years, participated in the study, which was published recently in the American Journal of Transplantation. Also participating in the study was Dr. Sunil Kurian, who heads Marsh's genomics research core team at Scripps.

Marsh is currently division chief of the Scripps Center for Organ Transplantation at Scripps Green Hospital. He performs liver, kidney and pancreas transplant operations, as well as administrative duties and research work.

The study involved a blood test that can help detect early signs of the body's rejection of a transplanted kidney, before the patient is suffering any symptoms, which Kurian called "silent rejection." This allows doctors to potentially treat the problem before it causes permanent damage to the transplanted kidney.

Until the development of this blood test, said Marsh and Kurian, the only way to detect such silent rejection of the transplant was a biopsy, in which a hollow needle is inserted into the kidney and a sample is removed for study.

Biopsies are more invasive, and carry such risks as bleeding and kidney damage, said Marsh. The procedure is also more time-consuming and expensive than a blood test, he said.

The blood test has the potential of helping about 20,000 people who have kidney transplants each year in the U.S., said a Scripps spokesman.

"We're pretty excited about it here," said Marsh about the new diagnostic test.

Researchers will conduct additional studies of the blood test's effectiveness as they seek approval of the procedure by the U.S. Food and Drug Administration. Also, the researchers hope the new test will soon be covered by Medicare and health insurance providers. Marsh said he expects the test to be available for Scripps patients within a few months, and the test will also be introduced at other medical centers in the U.S.

One potential benefit, said Marsh, is that patients may be more willing to have the blood test than an invasive biopsy, leading to earlier detection of any rejection issues.

"Just going to the lab and getting a blood draw is better than this multi-hour process of having a needle stuck into their kidney," he said.

Each year, Marsh said, patients who are three or four years out from their transplant and feeling fine may stop taking their medication. "Suddenly they have symptoms and their kidney is failing and I can't stop it," he said.

The hope is that if patients have the blood test and it reveals the warning signs of rejection, the problem can be treated before the kidney is damaged, thus prolonging the life of the transplanted kidney, Marsh said.

Kurian noted that about 16 percent of kidney transplants fail within the first five years.

Marsh said the blood test, which can be performed more frequently than biopsies, analyzes 56 genes which are related to the body's immune system, and whether the immune system is showing signs of what is called subclinical acute rejection, or subAR.

Previous to working at Scripps, Marsh worked in the transplant program at the University of Washington Medical Center. He trained at the Mayo Clinic in Rochester, New York, after graduating from medical school at Loma Linda University.

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