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Desensitization in HLA-incompatible Kidney Recipients and Survival

Desensitization in HLA-incompatible Kidney Recipients and Survival

Robert A Montgomery, Bonnie E Lonze, Karen E King, Edward S Kraus, Lauren M Kucirka, Jayme E Locke, Daniel S Warren, Christopher E Simpkins, Nabil N Dagher, Andrew L Singer, Andrea A Zachary, Dorry L Segev

N Engl J Med. 2011 Jul 28;365(4):318-26.

PMID: 21793744

Abstract:

Background:
More than 20,000 candidates for kidney transplantation in the United States are sensitized to HLA and may have a prolonged wait for a transplant, with a reduced transplantation rate and an increased rate of death. One solution is to perform live-donor renal transplantation after the depletion of donor-specific anti-HLA antibodies. Whether such antibody depletion results in a survival benefit as compared with waiting for an HLA-compatible kidney is unknown.
Methods:
We used a protocol that included plasmapheresis and the administration of low-dose intravenous immune globulin to desensitize 211 HLA-sensitized patients who subsequently underwent renal transplantation (treatment group). We compared rates of death between the group undergoing desensitization treatment and two carefully matched control groups of patients on a waiting list for kidney transplantation who continued to undergo dialysis (dialysis-only group) or who underwent either dialysis or HLA-compatible transplantation (dialysis-or-transplantation group).
Results:
In the treatment group, Kaplan-Meier estimates of patient survival were 90.6% at 1 year, 85.7% at 3 years, 80.6% at 5 years, and 80.6% at 8 years, as compared with rates of 91.1%, 67.2%, 51.5%, and 30.5%, respectively, for patients in the dialysis-only group and rates of 93.1%, 77.0%, 65.6%, and 49.1%, respectively, for patients in the dialysis-or-transplantation group (P<0.001 for both comparisons).
Conclusions:
Live-donor transplantation after desensitization provided a significant survival benefit for patients with HLA sensitization, as compared with waiting for a compatible organ. By 8 years, this survival advantage more than doubled. These data provide evidence that desensitization protocols may help overcome incompatibility barriers in live-donor renal transplantation. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and the Charles T. Bauer Foundation.).

Chemicals Related in the Paper:

Catalog Number	Product Name	Structure	CAS Number	Price
AP31528446	Mycophenolic acid-β-D-glucuronide solution		31528-44-6	Price

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