Innovations in Kidney Transplants May Help Thousands

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If you’ve never read the riveting novel My Sister’s Keeper by Jodi Picoult, you’ve probably at least seen, or heard about, the 2009 flick of the same title starring Cameron Diaz and Abigail Breslin.

Basically, the premise is this: The parents of a leukemia-stricken young girl conceive, via in vitro fertilization, another daughter for the sole purpose of being a genetic match for her sister, who needs blood, bone marrow and organ donations to stay alive.

When Kate, the sister with leukemia, goes into renal failure, the parents pressure Anna — the healthy sister — to donate a kidney because she’s the only perfect match.

While the story is a work of fiction, it resonates with the more than 93,000 people on the kidney transplant waiting list, who often wait between five and 10 years to find a donor. Often, the reason it takes so long for a successful transplant is because the donor must be a match for the recipient. In other words, the donor’s blood type and human leukocyte antigen (HLA) typing must be compatible with those of the person who needs the kidney.

But according to a new study, published this month in the New England Journal of Medicine (NEJM), there may now be hope for those struggling with dialysis while they wait desperately for a donor.

Methods and Results of the Research

For the study, doctors used an innovative procedure called “desensitization” to modify the immune systems of participants with renal failure. Specifically, desensitization is a process by which harmful antibodies, which can cause acute organ rejection from incompatible donors, are removed from the bloodstream.

The 1,025 participants in the treatment arm then received kidney transplants from living, HLA-incompatible donors. The researchers performed analyses to determine if desensitization reduced the risk of rejection — and had a significant survival benefit — compared to a group of control subjects who remained on the kidney transplant waiting list or received a transplant from a deceased donor.

The results so far have been promising. The longitudinal study showed that participants who received a transplant from a living, incompatible donor had an increased survival benefit compared to both control subjects who remained on the waiting list and those who received a kidney from a deceased donor. This survival benefit was true at all one-year, three-year, five-year, and eight-year follow-ups, with the HLA-incompatible kidney recipients having an increasingly higher benefit compared to controls over time.

For example, at the eight-year mark, 76.5 percent of participants who had received an HLA-incompatible kidney were still living, compared to 62.9 percent and 43.9 percent of controls who remained on the waiting list or received their kidney from a deceased donor and those who only remained on the waiting list, respectively.

The large-scale, 22-center study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases.

New Promise for Dialysis Patients

The results of the NEJM desensitization study may mean a lifeline for renal failure patients who have spent years enduring draining dialysis. Estimates suggest that, currently, up to 20 percent of people on the kidney transplant waiting list have such a high presence of organ-attacking antibodies that the chances of finding a compatible donor are slim to none. In addition, researchers say that, up until now, many patients with kidney disease have spent so much time on the waiting list that they give up and resign themselves to dialysis for the rest of their lives.

The implication of this new research is, ultimately, shorter wait times for renal failure patients to receive a transplant because desensitization means they don’t need a donor who is necessarily a genetic match. Even if the blood type and HLA typing are incompatible, the recipient has a significantly reduced risk of acute rejection — which leads to longer survival and better quality of life.

The Caveats

Despite the hope the novel desensitization procedure offers to patients with kidney disease, the process isn’t perfect just yet. First, desensitization can be expensive, costing an additional $20,000 to $30,000 above the price of the transplant itself. Still, nephrologists, or kidney doctors, say that in the long run, desensitization is cheaper than the price of a lifetime of dialysis, which can cost up to $70,000 per year.

Desensitization also takes time — the process usually lasts about two weeks, so the kidney can’t be from a deceased donor. Researchers suggest that patients find a living friend or relative willing to donate the organ, despite potential blood-type and HLA incompatibility.

But compared to a lifetime of dialysis, or the possibility of organ rejection from a deceased donor, the benefits of the procedure will likely outweigh the costs.

The Future of Desensitization Research

It may not just be renal patients who can improve survival with desensitization. While the research is still very preliminary, doctors think the next step is to apply this process to other forms of organ transplantation, such as in people with end-stage lung disease.

Technology isn’t just for smartphones, tablets and responsive stereo systems anymore. The advances in medicine are happening just as quickly.

So if you’re ever in need of a transplant, remember not to reject hope — because your body won’t reject that organ, either.

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