Need a Kidney? A New Approach Could Open Up the Options for Some
With desensitization, getting an incompatible organ is better than getting none, a major study finds
For some of the more than 100,000 Americans on the waiting list for a kidney right now, a new approach to kidney transplants could be life changing.
Currently, 13 people die every day while waiting for a kidney, according to the National Kidney Foundation. One problem is that a living donor willing to give up a kidney needs to be a good blood type and tissue type match. Otherwise, the recipient’s immune system might attack the new kidney.
Certain people are especially likely to reject a new kidney, and it appears doctors have found a way to help them. A new study shows the approach saves, or at least lengthen, lives compared with staying on a waiting list for the “right” match — and perhaps never getting one.
The technique aims to desensitize the immune systems of patients most likely to reject an incompatible organ. According to Johns Hopkins University School of Medicine, it involves filtering out antibodies designed to attack certain components of the immune system known as human leukocyte antigens or HLAs.
The study, published in the New England Journal of Medicine, looked at more than 1,000 people who received “incompatible” kidneys. After eight years, significantly more of these patients were alive compared with people who waited for a transplant and did or didn’t get one and people who got a kidney from a deceased donor (the other, less optimal, alternative for people who need an organ, in addition to dialysis).
Specifically, incompatible kidney recipients had an eight-year survival rate of 76.5 percent versus 62.9 percent for the waitlist-or-transplant group and 43.9 percent for the waitlist-only group.
Desensitization doesn’t eliminate the risk of organ rejection but decreases it.
According to Johns Hopkins, roughly 20,000 patients at any one time sit on a donor waiting list who are "highly sensitized and for whom finding a compatible donor is nearly impossible," says lead author Dorry L. Segev, MD, associate professor of surgery at the Hopkins School of Medicine. "That's a lot of people who could have a better chance at surviving if they are allowed to move forward with incompatible live donor transplantation."
"For the first time, we have definitively shown that incompatible live donor kidney transplantation provides almost twice the survival of a patient's next best option," Segev says. "This is great news for patients who have healthy, willing live donors but who have been relegated to the waiting list because of HLA incompatibilities.”
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