Staying Alive after a Kidney Transplant

Kidney transplant patients have better survival rate after receiving presurgery treatment

(RxWiki News) Kidney disease patients can wait years before they get a transplant. Even when they get a new organ, their body might reject it. Now, there is a way to make patient's bodies more accepting of transplants.

The pre-surgery treatment - which was developed at Johns Hopkins University - takes the problematic antibodies out of patients' blood before they go into transplant surgery. According to Dr. Montgomery, this treatment could lead to as much as 3,000 more kidney transplants from living donors every year.

"Get treatment before kidney transplant surgery."

People should be aware of this huge survival benefit, says Robert A. Montgomery, M.D., D. Phil., a professor of surgery at the Johns Hopkins University School of Medicine and leader of this study. He says that the findings should have an effect on those who make decisions in health care, including insurance companies, Medicare, and transplant centers.

Besides the fact that donor kidneys are in short supply, the biggest obstacle to having successful kidney transplants is the number of patients who have immune systems that are likely to reject most of the kidneys that are available.

“This type of technology could perhaps make it possible for thousands of renal patients to receive desperately-needed transplants," says Michelle Segovia of the Texas Organ Sharing Alliance. "Currently, those patients who do not have a friend or family member who match their particular blood and tissue type must wait years for a deceased donor kidney. While waiting, most patients have to undergo dialysis three times a week, three to four hours each day to filter toxins from the blood.”

Dr. Montgomery estimates that there are over 20,000 kidney transplant candidates in the United States for whom it is hard to find a kidney match. It is hard to find a match for these patients because their immune systems are likely to reject most kidneys. These patients have antibodies in their blood that respond to human leukocyte antigens (HLAs) - proteins that the immune system uses to spot what is foreign to the body.

People who have been exposed to foreign HLA in the past are called HLA-sensitized patients. Patients usually become HLA sensitized after pregnancy, blood transfusion, or an earlier kidney transplant.

The treatment works by removing the antibodies through a process called plasmapheresis - the removal, filtering, and replacement of a person's plasma. Then, the patient is given low doses of intravenous immune globulin - a blood product that is supposed to replace the problematic antibodies and keep them from coming back.

Basically, this process is supposed to get the body ready for a new organ. The process is performed every other day for a number of days before transplant surgery, and then for 10 days after surgery.

For their study, Montgomery and colleagues gave kidney transplants to 211 HLA-sensitized patients between 1998 and 2009. They performed the treatment on patients before and after surgery.

After one year, the transplant patients with incompatible kidneys were just as likely to survive as those who were still on dialysis waiting for a kidney. After eight years, however, those who got the treatment and transplant had a survival rate of 80.6 percent, compared to 30.5 percent for those on dialysis.

This treatment increases patients chance of survival, gives patients a better lifestyle, and saves money for the health care system, says Dr. Montgomery.

In some parts of the United States, insurance companies have not covered treatments such as this one. Dr. Montgomery says they should reconsider this.

The results of the study are published in the New England Journal of Medicine.

Review Date: 
July 28, 2011