Kidney Transplantation After Desensitization Ups Survival

Live-donor renal transplants performed after HLA desensitization significantly improve survival

WEDNESDAY, July 27 (HealthDay News) -- For patients with human leukocyte antigen (HLA) sensitivity, performing live-donor kidney transplants after HLA desensitization gives a significant survival benefit over waiting for an HLA-compatible kidney, according to a study published in the July 28 issue of the New England Journal of Medicine.

Robert A. Montgomery, M.D., D.Phil., from the Johns Hopkins Medical Institutions in Baltimore, and colleagues investigated whether live-donor renal transplantation after the depletion of donor-specific anti-HLA antibodies gives better survival results than waiting for an HLA-compatible kidney. A total of 211 HLA-sensitized patients underwent plasmapheresis and desensitization with low-dose intravenous immune globulin before renal transplantation (treatment group). Death rates were compared between patients undergoing desensitization, and two matched control groups waiting for a kidney transplantation who continued to undergo dialysis (dialysis-only group) or underwent either dialysis or HLA-compatible transplantation (dialysis-or-transplantation group).

The investigators found that Kaplan-Meier estimates of patient survival in the treatment group were 90.6 percent at one year, 85.7 percent at three years, and 80.6 percent at five and eight years. For patients in the dialysis-only group, rates were 91.1 percent at one year, 67.2 percent at three years, 51.5 percent at five years, and 30.5 percent at eight years, while in the dialysis-or-treatment groups, rates were 93.1, 77.0, 65.6, and 49.1 percent, respectively. Survival rates were significantly higher in the treatment group compared with the dialysis or dialysis-or-treatment groups.

"Live-donor transplantation after desensitization provided a significant survival benefit for patients with HLA sensitization, as compared with waiting for a compatible organ. By eight years, this survival advantage more than doubled," the authors write.

Several of the study authors disclosed financial ties with the pharmaceutical industry, and Johns Hopkins Medical Institutions received grants from the pharmaceutical industry for HLA-incompatible transplantation.

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