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Kidney Transplants: A Far Cry

Shipped organs more likely to fail

WEDNESDAY, Oct. 24, 2001 (HealthDayNews) -- The risk that a kidney transplant will fail in the first year goes up significantly if the organ must be shipped to the recipient and if there is even a slight mismatch between the donor and the patient who gets it, a study finds.

It is a finding that could affect a long-running debate about the best way to allocate all donor organs, not just kidneys, says Dr. Kevin C. Mange, assistant professor of medicine at the University of Pennsylvania and leader of the study group.

One side of the debate says consideration should be given first to patients in the area of the local transplant organization where the organ is donated. The other side says an organ should go to the patient who needs it most, regardless of location.

The study was done because "whether the movement of kidneys had any impact on survival was not known at all," Mange says. His group identified 5,446 cases in which two kidneys were taken from a deceased donor, and one was transplanted locally while the other was shipped to a more distant recipient.

If the donor kidney matched the recipient's immune system perfectly on the standard scale used to determine a match, the chance of a failure in the first year was the same regardless of the distance the organs were shipped, says a report in the New England Journal of Medicine. But overall, a transplant using a shipped kidney was 17 percent more likely to fail in the first year than one used locally.

The risk of failure goes up with the degree of mismatch and with the time needed to ship the kidney, a period during which the organ is kept refrigerated and without a blood supply, the study found. About 12,000 kidney transplants are performed every year; about 50,000 people in the United States are now waiting for a kidney, according to the United Network for Organ Sharing (UNOS).

"If there is any level of mismatching, it seems that moving organs between organizations has a detrimental effect on survival," Mange says. But he adds: "The implication is not that we should not be shipping organs, but that we should re-evaluate our national policy on organ allocation to be sure that moving kidneys between organizations is the best thing to do."

And although this study is limited to kidney transplants, it has greater implications for transplants of such other organs as livers and hearts, Mange says. While most kidney patients can be kept alive by artificial kidney treatment, there is no such backup for patients awaiting liver, heart or lung transplants, he says.

"The allocation of livers should be re-evaluated," Mange comments.

That re-evaluation is going on now, says Joel Newman, a spokesman for UNOS, which oversees the nation's transplant program. Liver transplants are the second most-common procedures, behind kidney transplants. As of Oct. 5, 18,488 Americans are awaiting liver transplants. There were 4,950 such transplants in the United States last year, and 1,674 patients died before they could get transplants.

Donated livers now are allocated according to a complex formula that takes into account the cause of liver failure and sophisticated measures of liver function, Newman says. In general, preference is given first to patients in the local organization.

A special subgroup of the UNOS committee on liver transplants is preparing specific recommendations, which it expects to issue before the end of the year, Newman adds.

What To Do

You can help save lives by signing donation cards for your liver and other organs to help ease the shortage.

For more information on how kidneys work and fail, try the National Kidney Foundation. The United Network for Organ Sharing and the Organ and Tissue Donation Initiative have more on transplants, while the American Association of Kidney Patients focuses on those suffering from kidney failure.

SOURCES: Interviews with Kevin C. Mange, M.D., assistant professor of medicine, University of Pennsylvania, Philadelphia; Joel Newman, spokesman, United Network for Organ Sharing, Richmond, Va.; Oct. 25, 2001, New England Journal of Medicine
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