New procedure allows use of kidney from any donor

Mr Clint Smith underwent the procedure and received a kidney from a friend four years ago. The organ is still functioning.
Mr Clint Smith underwent the procedure and received a kidney from a friend four years ago. The organ is still functioning.

Desensitisation alters immune systems so transplant patients won't reject organ: Study

NEW YORK • Researchers have found a way for kidney patients to have a transplant without fear that the organ would be rejected, according to a national study that experts are calling revolutionary.

In the new study, published in The New England Journal of Medicine on Wednesday, doctors successfully altered patients' immune systems to allow them to accept kidneys from incompatible donors. Significantly, more of those patients were still alive after eight years than patients who had remained on waiting lists or received a kidney transplanted from a dead donor.

The method, known as desensitisation, "has the potential to save many lives", said Dr Jeffery Berns, a kidney specialist at the University of Pennsylvania's Perelman School of Medicine and the president of the US National Kidney Foundation.

It could slash the wait times for thousands of people and, for some like lawyer Clint Smith, 56, this could mean the difference between getting a transplant and spending the rest of their lives on dialysis.

Researchers say about half of the 100,000 people in the US waiting for a transplant have antibodies that will attack a new kidney, and about 20 per cent are so sensitive, finding a compatible organ is all but impossible. In addition, said Dr Dorry Segev, lead author of the new study and a transplant surgeon at the Johns Hopkins University School of Medicine, an unknown number of people with kidney failure simply give up on the waiting lists after learning that their bodies would reject just about any organ. Instead, they resign themselves to dialysis, a difficult and draining procedure.

Desensitisation involves first filtering the antibodies out of a patient's blood. The patient is then given an infusion of other antibodies to provide some protection while the immune system regenerates its own antibodies.

For some reason - exactly why is not known - the person's regenerated antibodies are less likely to attack the new organ, Dr Segev said. But if the person's regenerated natural antibodies are still a concern, the patient is treated with drugs that destroy any white blood cells that might make antibodies that would attack the new kidney.

The process is expensive, costing US$30,000 (S$41,000), and uses drugs not approved for this purpose. The transplant costs about US$100,000. But kidney specialists argue that desensitisation is cheaper in the long run than dialysis, which costs US$70,000 a year for life.

In the new study, 1,025 patients at 22 medical centres who had an incompatible donor were compared to an equal number of patients who remained on waiting lists for an organ or who had an organ from a dead but compatible donor.

After eight years, 76.5 per cent of those given an incompatible kidney were still alive, compared with 62.9 per cent who remained on the waiting list or received a dead-donor kidney and 43.9 per cent who remained on the waiting list but never got a transplant.

The procedure "changed my life", said Mr Smith, who had a transplant after his kidneys failed in 2004. The transplanted organ failed after 61/2 years and he went on dialysis, until he had the desensitisation procedure and received a kidney from a friend. That was four years ago, and the new kidney is still functioning.

NEW YORK TIMES

A version of this article appeared in the print edition of The Straits Times on March 11, 2016, with the headline 'New procedure allows use of kidney from any donor'. Print Edition | Subscribe