The Kidney & the Cancer

No one ever expected a doctor to have a good word to say about cancer, but this week a team of physicians and surgeons at Manhattan's Memorial Sloan-Kettering Cancer Center came as close to doing so as scientific caution would permit. A kidney transplanted from a cancer patient, it seems, may have a better chance of survival than one taken from a healthy donor.

Why this should be so, the doctors are not sure. It is known that patients with advanced cancer have little or no capacity for rejecting foreign tissue, and this makes it easier for them to accept transplants. Now the doctors suggest in the medical journal Transplantation that the converse may also be true: cancer victims' tissues, even from healthy parts of the body, may lack certain antigens involved in the rejection mechanism, making them an unexpectedly good source of transplants.

The almost accidental discovery was made after doctors at Memorial had all but given up hope for a patient dying of renal failure. The vaunted artificial kidney could no longer clear the poisons from his blood, and only a transplant offered any hope. But the only kidney available was far from promising. The donor had type A blood while the kidney patient had type O. Worse, the donor's kidney was infected and was about to be removed because it was draining improperly. It had already been physically damaged by obstruction resulting from cancer of the colon.

To make the operation even more ominous, the recipient had a number of severe congenital abnormalities. These had led to repeated urinary-tract infections, and caused in turn, congestive heart failure, high blood pressure, and the formation of kidney stones. Now, on top of everything else, he had anemia and inflammation of the heart sac.

Surgeon Walter Lawrence Jr. made the transplant anyway. To the doctors' astonishment, there was no rejection process. Ten weeks after surgery, the 36-year-old man went back to work as a telephone operator. Sixteen months have now elapsed and he reports that he never felt better.

Although the fact that the unpromising transplant worked so well seems to be a result of the donor's cancer, the possibility remains that in this case the recipient had an inborn weakness of the rejection system. The doctors are now checking that possibility too. But they are fascinated by the idea that organs from cancer patients may be surprisingly suitable for transplants.

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