Revolutionary method could save countless people from life-long dialysis
Many people around the world are waiting for a new kidney to be transplanted. However, tens of thousands of patients are also on the waiting lists, who will probably never get a new kidney because their immune system would reject the transplanted organ. That could change in the future. Researchers now seem to have found a way for the patient's immune system to accept the kidneys of actually incompatible donors.
Physicians from the Johns Hopkins University School of Medicine have now, in a large national study, developed a way to change the immune system of patients so that it accepts a transplanted kidney from incompatible donors. The revolutionary result was published by the scientists in the journal "The New England Journal of Medicine".
So-called desensitization can save many lives
The researchers have developed a way in which our immune system also accepts the kidneys of actually incompatible donors. The new procedure is known as desensitization, the doctors explain. The treatment has the potential to save many lives. It could shorten waiting times for thousands of people, and for some sufferers, it would make the difference between a transplant and the rest of their lives as a dialysis patient. The process can completely change the lives of many people and save them long dialysis times and their unpleasant side effects, the experts emphasize.
Many people wait in vain for a donor kidney all their lives
Scientists estimate that about half of the 100,000 people in the United States on kidney transplant lists have antibodies that would attack a transplanted organ. In addition, about 20 percent of those affected are so sensitive that finding a compatible organ is next to impossible, the researchers explain. An unknown number of kidney failure patients decline the waiting lists after learning that their bodies will reject almost every transplanted organ. Instead, such people come to terms with lifelong dialysis. A strenuous and exhausting procedure that has a very large negative impact on the lives of those affected, says lead author Dr. Dorry Segev from Johns Hopkins University School of Medicine.
How does so-called desensitization work?
So-called desensitization involves filtering the antibodies from a patient's blood. Those affected are then given an infusion of other antibodies. This provides some protection while the immune system regenerates its own antibodies, the doctors explain. For some unknown reason, the regenerated antibodies are less likely to attack a transplanted organ. If the antibodies continue to be a problem, the patient is treated with drugs that destroy his white blood cells. The experts explain that these can form the antibodies that would attack a new transplanted kidney. By far the greatest use of desensitization would be possible in kidney transplants. However, the procedure could also be suitable for live donation transplants of the liver and lungs, the researchers say. The liver is less sensitive to antibodies, which is why there is less need for desensitization. But such treatment would surely be possible if there were intolerance, says Dr. Segev. In the case of lungs, so-called desensitization is also theoretically possible, although such treatment has not yet been carried out.
Very good survival rate despite incompatible kidney
The new study examined 1,025 patients in 22 medical centers. Those affected did not have a compatible donor and were compared to patients who had received the organ of a deceased compatible donor. After eight years, 76.5 percent of those who received desensitization and an incompatible kidney were still alive. Compared to 62.9 percent who remained on the waiting list and received a donor kidney from a deceased person. The figure was 43.9 percent if those affected remained on the waiting list but never received a transplant, the experts add.
Patients with desensitization need a living donor
The process of desensitization takes time, in some patients it takes about two weeks. Desensitization is done before the transplant, so patients need a living donor. It is not known how many people are willing to donate a kidney, but doctors say that they often see situations in which a relative or even a friend is willing to donate their organ, but it is unfortunately not compatible. Patients often have to be informed that their living donors are not compatible, which is why they are stuck on the waiting lists for a deceased donor, says Dr. In recent years, however, there has been another option in some countries - a so-called kidney replacement. Patients who were incompatible with their living donors could exchange these donors with someone whose donor organ was compatible with them. (as)