SUMMARY
The research of nephrologist Lavanya Kodali, M.B.B.S., M.D., focuses on the care of people with a kidney or a combined kidney and pancreas transplant. She also evaluates individuals with chronic kidney disease to determine if they are medically able to undergo transplantation.
One of the challenges faced in the evaluation of elderly people for a kidney transplant is the assessment of frailty. Although there are some available tools to assess frailty objectively, they do not always provide the complete picture. To complicate things further, it is unknown how physical frailty and aging, especially in the setting of chronic kidney disease, affect the immune system.
Dr. Kodari studies aging of the immune system and identifies markers of an aging immune system. This research is important in predicting the outcomes following transplant. Infection, malignancy and heart disease are the major causes of death following kidney transplantation. Immunosuppression, with medicines to prevent organ rejection, plays a major role in the development of infections and malignancies after transplantation.
Dr. Kodali is currently involved in studying blood samples from people 65 years and older who are on the waiting list for a kidney transplant. She compares these samples to blood samples from people 65 years and older who have received a kidney transplant. This lets Dr. Kodari identify changes in the immune markers of aging. Dr. Kodari can then regulate dosing of immunosuppressive medication and lower the risks of infections, malignancies and rejection.
Identifying and defining the phenotype for an aging immune system also can help with predicting complications following transplant. Dr. Kodari develops targeted therapies to prevent or even reverse immunosenescence. Immunosenescence is the change in the immune system that happens with aging.
Focus areas
- Identify markers of immunosenescence.
- Develop cellular based therapies, such as chimeric antigen receptor T-cell therapy known as CAR-T, to prevent or reverse immunosenescence. CAR-T cells are immune cells that destroy cancer cells.
- Decrease the risk of infections, cancers and rejections after transplant by using personalized medicine.
- Prevent scarring in the transplanted organ and thus prolong the life of the organ.
Significance to patient care
Dr. Kodali identifies blood markers of an aging immune system and correlates them with physical or phenotypic markers. This helps to provide personalized treatment after transplantation with a goal to minimize complications of infections, malignancies and rejections. Once the markers are identified, cellular based therapies (CAR-T) are used to prevent or even reverse immunosenescence.
Scarring of the transplanted organ is one of the major causes of graft failure. This scarring adds a strain on the existing supply of limited organs and increases the challenges to people who need organs. Dr. Kodali's research decreases the re-transplant process with increased immunosuppression exposure. Dr. Kodali identifies therapies to reverse scarring in the transplanted kidney and prolong the life of the organ.
Developing immune tolerance, using minimal immunosuppression to prevent organ rejection and other complications with immunosuppressive medicine, is another area of interest for Dr. Kodali.
Professional highlights
- Mayo Clinic Investment for Extramural Grants Award, Immunosenescence in Elderly Transplantation, Mayo Clinic, 2023-2024.