Family Spotlight

Less Than Two Years Since Her Liver and Kidney Transplant,
COTA Patient Dyamond Ott is Enjoying Her Summer to the Fullest

As a toddler, Dyamond Ott itched her legs until they were raw and got out of bed at night to rub her feet on the carpet – often until she had blisters. This little girl would constantly tell her parents, “my bones itch.” She also required more sleep than most children.

After many medical tests and opinions, physicians confirmed Dyamond was correct in thinking her bones itched, but it was actually her blood causing the internal irritation. By the time Dyamond was six years old, she was diagnosed with a liver disease called Progressive Familial Hepatic Cholestasis Type 3 and a blood disease called Congenital Hemolytic Anemia. Her liver was deteriorating rapidly and her red blood cells were dying quickly. To combat these conditions, Dyamond took nine medications each day and endured countless medical tests and procedures. At the same time, Dyamond’s family was told that younger sister, Dallas, had the same liver disease. However, Dallas’ disease was not progressing as quickly as
Dyamond’s was.

By the age of 12, Dyamond was sent to The Nebraska Medical Center for further evaluation. The specialists there confirmed her two diagnoses, but added another to the list – a kidney disease called Advanced Global Glomerulosclerosis. To survive, Dyamond needed a liver and kidney transplant. In July 2006, Dyamond was placed on the national waiting list for a liver and a kidney. At the same time, her family called the Children’s Organ Transplant Association (COTA) for assistance. Friends and family members in her Ankeny, Iowa, hometown rallied to do anything they could to help.

Less than three months later, on September 21, 2006, Dyamond received a second chance at life when one donor gave a liver and a kidney.

Dyamond’s recovery has been slow, and she has to be reminded she received two organs and her recovery will take time. Dyamond’s passion is dancing and she wants to keep working toward her goal of becoming a professional dancer ... and living life to the fullest.

According to Dyamond’s mother, Diane Ott, “COTA took the guessing out of how our friends and family members could help our family. This brought us great hope. COTA gave us such peace of mind that we were not alone. Our donor family also provided us the ultimate hope. We are so grateful to them, to our COTA team, and to all the wonderful people we have met throughout this transplant journey.”

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Transplants Today

New Technology Enhances and Expands “Homing” and Therapeutic Potential of Cord Blood Stem Cells in Bone Marrow Transplants

Kent W. Christopherson II, PhD, Assistant Professor of Medicine and researcher in the Sections of Hematology and Stem Cell Transplantation at Rush University Medical Center, is researching a CD26 Inhibitor, a small molecule enzyme inhibitor that enhances directional homing of stem cells to the bone marrow by increasing the responsiveness of donor stem cells to a natural homing signal. Homing is the process by which the donor stem cells find their way to the bone marrow. It is the first and essential step in stem cell transplantation.

According to Dr. Christopherson, a CD26 Inhibitor increases the efficiency and responsiveness of umbilical cord blood for bone marrow transplants and may improve care for blood cancer.

Cord blood is increasingly being used by transplant centers as an alternative source of stem cells for the treatment of blood cancers, including myeloma, lymphoma and leukemia. The cells, which are collected from the umbilical cord after the baby is delivered and separated from the cord, are most commonly used for bone marrow transplantation when a donor from a patient’s family or an unrelated donor does not produce an appropriate bone marrow match.

The current drawback to the usage of cord blood cells is that due to the limited volume and cell number, there are generally only enough cells available from a single cord blood collection for children or very small adults. Cord blood cells also usually take longer to engraft, leaving the patient at a high risk for infection longer than donor matched transplanted marrow or peripheral blood stem cells. The goal of Dr. Christopherson’s research is to increase the transplant efficiency of umbilical cord blood and ultimately make transplant safer and available to all patients who require this treatment.

In his discussion on “Strategies to Improve Homing,” Dr. Christopherson states that results from his and other laboratories suggest, “the beneficial effects of the CD26 Inhibitor usage and the potential of this technology to change hematopoietic stem cell transplantation.”

Dr. Christopherson is working with Patrick Zweidler-McKay, PhD, of the University of Texas MD Anderson Cancer Center. Dr. Zweidler-McKay’s team is studying Engraftin™, a human recombinant enzyme technology that increases the efficiency of engraftment and reduces graft failure in transplantation of cord blood derived stem cells.

Research results in animal models by Dr. Christopherson and Dr. Zweider-McKay show that both Engraftin and CD26 Inhibitor can enhance homing and rate of engraftment, which should result in reduced patient morbidity and mortality in bone marrow transplants. American Stem Cell, Inc., the developer of both technologies, plans to begin human trials in the next few months.

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Sirolimus Linked to New-Onset Diabetes Following Renal Transplant

"Patients who develop diabetes after transplantation have roughly the same risk of transplant failure as patients who develop acute transplant rejection," according to Dr. John S. Gill, University of British Columbia in Vancouver, Canada, in a large registry study reported in a recent issue of the Journal of the American Society of Nephrology.

Because single-center studies indicating that sirolimus may be diabetogenic have not been replicated in larger trials, Dr. Gill's team evaluated data from the United States Renal Data System for the period between 1995 and 2003. Their analysis included 20,124 nondiabetic adult recipients of a first kidney transplant. Nearly 2,600 were prescribed sirolimus in combination with other immunosuppressants.

The three-year cumulative incidence of new-onset diabetes was highest for patients treated with sirolimus plus cyclosporine A (21.9%) and sirolimus plus tacrolimus (21.5%). Sirolimus in combination with mycophenolate mofetil or azathioprine (MMF/AZA) was associated with a cumulative incidence of 17.8%.

In comparison, the cumulative incidence of diabetes was 19.0% among those treated with tacrolimus and MMF/AZA. The lowest incidence was observed among patients treated with cyclosporine A plus MMF/AZA (15.6%).

After adjustment for multiple confounders, including corticosteroid use and acute rejection during the first post transplantation year, treatment with sirolimus in any combination was associated with increased risk for new-onset diabetes compared with the reference group (patients treated with cyclosporine A and MMF/AZA). Hazard ratios ranged from 1.36
to 1.66.

"Given the importance of new-onset diabetes as a determinant of post transplantation outcomes and the current use of sirolimus in both pancreas and islet cell transplantation," Dr. Gill's team concluded, "the findings of our study should be confirmed in further prospective studies or in meta-analyses of existing trials using sirolimus."

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COTA News

COTA Will Soon Be Surveying Transplant Professionals

COTA wants to continue to improve our programs and services, and we need your help. We will be unveiling a new online surveying tool later this fall to get your thoughts and opinions about COTA. Watch for this survey and when it comes, please take a moment to complete it as directed on the survey tool. COTA is committed to being a trusted resource to the nation’s community of transplant professionals; we need your feedback and comments to do so.

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COTA Fast Fact

The Children’s Organ Transplant Association (COTA) provides Extensive Volunteer Training and Support. Telephone orientation sessions; training for local volunteers by a professional staff member; and materials, web-based templates and ongoing support are provided to COTA’s fundraising campaigns. Customized guidance and programs are developed to meet the unique needs of each family and volunteer group. Throughout the entire fundraising campaign, COTA’s staff is available to provide information and assistance, as well as practical solutions to fundraising challenges.

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