This year, only about 17,000 of the 100,000 Americans on kidney transplant waiting lists will receive a new organ. About 12,000 of these kidneys will come from deceased donors, a number that is not growing, and approximately 5,000 will be donated by a family member or friend.
Doctors have long hoped the number of living-donor transplants would grow more rapidly, cutting into the huge waiting list. But even among patients with renal disease who have a family member or acquaintance willing to be a donor, many times the two are found to be medically incompatible.
Now, there’s increased hope for these renal patients who have a potential kidney donor.
A study published in the New England Journal of Medicine on de-sensitization techniques performed over the past eight years at 22 transplant centers showed that kidneys can be successfully transplanted from living donors previously not viewed as a suitable match.
The 1,000-plus patients in the study were compared to the same number of patients who remained on the organ donor waiting list. After eight years, 76.5 percent of those who received what used to be considered incompatible kidneys using this de-sensitization process were still alive compared to only 43.9 percent of those who never got their transplant.
More widespread use of these de-sensitization techniques would appear to have the potential to greatly increase the number of living-donor transplants.
Dr. Saatiah Jaffry at Coastal Kidney Care & Hypertension and the Sebastian River Medical Center emphatically says anyone currently waiting for a kidney transplant should “absolutely” contact their nephrologist at this time.
“They should (also) talk to their transplant center,” Jaffry adds.
Up to half the people on the transplant waiting lists have antibodies in their immune systems that will attack a transplanted organ.
The research led by Johns Hopkins centered, according to Jaffry, on HLA or human leukocyte antigens.
According to the University of California health system, these antigens are what allow the body to protect itself by recognizing and attacking anything foreign in the body such as bacteria or viruses.
However those same antigens also see the tissue of a transplanted organ as different from its own and promptly begin attacking the new organ.
The Hopkins study found a way to largely resolve this problem through a process known as “de-sensitization.”
The CliffsNotes version of de-sensitization might go something like this: “Existing antibodies in a transplant patient’s blood are filtered out. The patient is then given an infusion of plasma with other antibodies. Drugs are then given to destroy any white blood cells that might attack the new organ.”
However it’s described, the results of de-sensitization have been impressive.
Another major problem with organ transplants, according to Jaffry, is “ABO.”
Jaffry explains that if an organ donor is blood type A and the recipient is blood type O, the recipient’s body will reject the organ. But the issue of blood type incompatibility has been successfully treated as far back as 1989 through a process called “plasmapheresis.”
Plasmapheresis, says Jaffry, involves removing plasma from the patient and replacing it with plasma from pooled or multiple donors. This, she says, makes the incompatibility of blood types “go away.”
Jaffry also cites “pooled immunoglobulins” and “immune absorption” processes as well as chemotherapy drugs such as Rituximab as key ways of resolving ABO blood incompatibilities.
Since 31 million Americans currently have some form of chronic kidney disease, many will eventually need a kidney transplant or face what’s left of their lives undergoing dialysis.
The de-sensitization process does take time. Sometimes it requires two or more weeks and, according to the Times, it’s expensive.
The de-sensitization process costs about $30,000, while the actual transplant operation carries a price tag of around $100,000.
But that combined expense may actually qualify as something of a bargain.
The cost of dialysis treatments runs upwards of $70,000 a year, so in two years the de-sensitization and transplant procedures are actually less expensive than dialysis.
Moreover, Jaffry points out, dialysis patients tend to have more hospitalizations and more cardiovascular problems than transplant recipients.
There is, however, one fly in this particular ointment.
Drugs such as Rituximab have not – as yet – been specifically approved by the FDA for use in transplant procedures and, according to Jaffry, “The major problem with using not (specifically) FDA-approved drugs is getting insurance (companies) to pay for it.”
Nonetheless the Hopkins study is already having a big impact.
“I was talking to a transplant nephrologist in Orlando,” Jaffry says, “We have a lot of patients in common, so I said this article just came out. It’s really interesting. Do you think you guys are going to do a lot more (de-sensitization procedures)and he said yes.”
Dr. Saatiah Jaffry can be reached at Coastal Kidney Care & Hypertension at 7965 Bay Street, Suite Six in Sebastian. The phone number is 772-918-8487.