Kidney Disease Research Updates
Desensitization Protocol Increases Survival in Kidney Recipients
More than 90,000 people with end-stage renal disease are on the waiting list for a kidney transplant. Of these, more than 20,000 are sensitized to human leukocyte antigen (HLA) so that their bodies will reject all but the most compatible kidneys, increasing their time on the waiting list.
A team of researchers at The Johns Hopkins University School of Medicine—led by Robert A. Montgomery, M.D., and supported in part by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)—has developed a protocol that desensitizes a potential kidney recipient to a specific live-donor’s HLA.
The protocol included a process— plasmapheresis—that filters the blood of the kidney recipient to deplete it of donor-specific anti-HLA antibodies. Another step in the protocol was to administer low-dose intravenous immunoglobulin. Finally, a kidney from the livedonor was transplanted.
The study included three groups: (1) the treatment group, i.e., the desensitized kidney recipients, (2) a control group from the waiting list that received dialysis only, and (3) another control group that underwent either dialysis or HLA-compatible (conventional) transplantation. The treatment group included 211 patients treated from 1998 to 2009. The control groups were carefully matched to the treatment group. For each member of the treatment group, five matching individuals were selected from the kidney transplant waiting list. The matching individuals were then divided into the two control groups.
The results of the study were published in The New England Journal of Medicine. What Montgomery and colleagues found was that the desensitization and transplantation protocol bestowed a far better survival rate over the patients who received dialysis only or who received either dialysis or conventional transplantation. While the differences were small in the first year, they increased substantially as the years passed. After 8 years, the desensitized treatment group had an 80 percent survival rate. Only 30 percent of the dialysis-only group survived 8 years. The dialysis-or-transplant group had a somewhat better 49 percent survival rate.
While adding plasmapheresis increases the cost of treatment, prolonged dialysis is much more expensive in the long run. Montgomery and colleagues concluded, “These data provide evidence that desensitization protocols may help overcome incompatibility barriers in live-donor renal transplantation and provide a substantial survival benefit for those who are offered this new modality.”
The National Kidney and Urologic Diseases Information Clearinghouse, part of the NIDDK, offers fact sheets and easy-to-read booklets about the kidneys, kidney disease, and treatments for kidney failure. For more information or to obtain copies, visit www.kidney.niddk.nih.gov.
NIH Publication No. 12–4531
Page last updated June 26, 2012