Desensitization in HLA-incompatible kidney recipients and survival.

Academic Article

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.).
  • Authors

    Published In

    Keywords

  • Adult, Case-Control Studies, Desensitization, Immunologic, Female, Histocompatibility Testing, Humans, Immunoglobulins, Intravenous, Immunosuppressive Agents, Kaplan-Meier Estimate, Kidney Failure, Chronic, Kidney Transplantation, Living Donors, Male, Middle Aged, Mycophenolic Acid, Plasmapheresis, Renal Dialysis, Tacrolimus, Transplantation Conditioning, Transplantation Immunology
  • Digital Object Identifier (doi)

    Pubmed Id

  • 7623152
  • Author List

  • Montgomery RA; Lonze BE; King KE; Kraus ES; Kucirka LM; Locke JE; Warren DS; Simpkins CE; Dagher NN; Singer AL
  • Start Page

  • 318
  • End Page

  • 326
  • Volume

  • 365
  • Issue

  • 4