WASHINGTON–Nearly one in three patients who need a kidney transplant may never get one because their bodies are abnormally primed to attack a donated organ. Now doctors are trying new ways to outwit the immune system and save more of those so-called
WASHINGTON–Nearly one in three patients who need a kidney transplant may never get one because their bodies are abnormally primed to attack a donated organ.
Now doctors are trying new ways to outwit the immune system and save more of those so-called “highly sensitized” patients—often with kidneys donated by living donors, considered the optimal kind.
“I feel very lucky. Our son saved my life,” said Cynthia Preloh of Arlington, Va., after an unusual combination of blood cleansing and a cancer drug allowed her to receive a kidney from her son that her body otherwise would have destroyed.
It’s promising work that comes as the nation’s kidney distribution system is beginning a major overhaul. Together, the two efforts aim to make a long-needed dent in the years of waiting it can take to get a kidney transplant.
That’s crucial because “your chance of getting successfully transplanted decreases with time,” says Dr. Keith Melancon of Georgetown University Hospital, Preloh’s surgeon and a leader in the small but growing field of incompatible kidney transplants.
More than 77,000 people are on the national waiting list to receive a kidney from a deceased donor. Yet fewer than 17,000 transplants a year are performed, about 10,500 of them from deceased donors and just over 6,000 from living donors, relatives or friends who offer to help a specific patient. The wait can stretch four to five years, and more than 4,000 patients die on the waiting list each year.
A transplant starts by matching patient and donor kidney according to blood and tissue type. Today’s anti-rejection drugs are so good that tissue-typing can be far from perfect.
A different threat is what’s called antibody-mediated rejection, where patients increasingly are “sensitized” — their bodies produce antibodies that are super-vigilant at attacking most available kidneys. What causes that? Pregnancy, blood transfusions, a previous transplant, increased time on dialysis. So longer transplant wait times are fueling sensitization, a vicious cycle.
The more antibodies, the harder it is to find a compatible kidney. So the quest is to rid patients of antibodies targeted to a specific donated kidney and keep them from making more.
One method: Filtering a patient’s blood, called plasma pheresis, before transplant. Another is intravenous immune globulin, or IVIG, a mix of infection-fighting antibodies that basically crowd out the bad kidney kind with run-of-the-mill types. They’re treatments pioneered at a few hospitals—including Los Angeles’ Cedars-Sinai Medical Center and Baltimore’s Johns Hopkins University—and now slowly spreading. AP
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