 |
|
New protocol streamlines therapy that makes more kidney transplants possible
July 17, 2008A new therapy developed at Cedars-Sinai Medical Center improves transplant rates and outcomes for patients awaiting living- and deceased-donor kidney transplantation, according to a study published in the July 17 issue of the New England Journal of Medicine.
The therapy may provide an option for many patients "sensitized" to transplant antigens (human leukocyte antigens, or HLA) who previously would not have been candidates for transplantation because of their intense immune response to these HLA targets.
HLA exposure can come through blood transfusions, previous transplantation or pregnancy. Once exposed, the immune system is sensitized to those antigens and develops antibodies to fight them. If a donor organ with the antigens is later transplanted, the antibodies respond, increasing the risk of rejection and loss of the organ. Antibodies to HLA were previously considered an absolute contraindication to transplantation - the risk was too high for transplantation to be an option.
About 30 percent of the 74,000 patients on the transplant waiting lists for a deceased-donor kidney are sensitized, and those with exceptionally high antibody levels are considered especially poor candidates for transplantation. In fact, each year only 6.5 percent of highly sensitized patients receive a transplant. Most remain on dialysis indefinitely, without hope for a life-saving transplant.
"From a quality-of-life perspective, as well as from the financial standpoint, transplantation is a much better option than years of dialysis," said Stanley C. Jordan, M.D., director of the Division of Nephrology and medical director of the Renal Transplant Program at Cedars-Sinai. The senior author of the journal article, Jordan developed high-dose intravenous immunoglobulin (IVIG) therapy to "desensitize" highly sensitized patients and increase their chances of successful transplantation. The approach became a Medicare-approved therapy in 2004 at the conclusion of a National Institutes of Health-funded multicenter study.
Cedars-Sinai is a national leader in desensitization for the highly HLA sensitized patient, offering therapy for those awaiting both living-donor and deceased-donor transplantation.
The New England Journal article describes a Phase I/II safety and limited efficacy trial of a combination of IVIG and rituximab, a monoclonal antibody - an antibody engineered to bind to a specific protein. The combination of IVIG and rituximab appears to offer superior benefits to IVIG alone, improving transplant rates to 80 percent of treated patients. The one-year patient and graft survival rates were 100 percent and 94 percent, respectively.
Based on these results, the new protocol is less costly than IVIG alone yet appears to be highly effective in reducing antibody levels and improving transplantation rates. Larger, multicenter trials are necessary to confirm these findings.
Because nearly one-third of kidney failure patients are highly sensitized and few transplant centers specialize in desensitization therapy, many potential candidates are told that a transplant simply is not possible.
"Patients who are on dialysis and those who are progressing toward renal failure should be considered for a kidney transplant. Ideally, they would be referred to a transplant center for evaluation even before they start dialysis because data show that those who get transplanted before starting dialysis do better," Jordan said. "However, for the highly sensitized patient, transplantation is not an option unless desensitization therapies are used."
Jordan estimates that about 40 percent of Cedars-Sinai's kidney transplant patients are highly sensitized and are referred or self-referred to the program because of their highly sensitized state. For many patients, especially those awaiting a deceased-donor transplant, the combination of IVIG and rituximab appears to offer an alternative to ongoing dialysis.
The New England Journal of Medicine article is accompanied by an editorial written by Ron Shapiro, M.D., of the Thomas E. Starzl Transplantation Institute at the University of Pittsburgh. He concludes his comments by saying, "As the authors note, their observations need to be confirmed and validated by other centers and in larger numbers of patients and during longer periods of follow-up. However, their approach may represent a breakthrough in the care of sensitized patients awaiting transplantation and may have the potential to help thousands of patients who are languishing on waiting lists around the world."
Cedars-Sinai Medical Center
About 30 percent of the 74,000 patients on the transplant waiting lists for a deceased-donor kidney are sensitized, and those with exceptionally high antibody levels are considered especially poor candidates for transplantation. In fact, each year only 6.5 percent of highly sensitized patients receive a transplant. Most remain on dialysis indefinitely, without hope for a life-saving transplant.
"From a quality-of-life perspective, as well as from the financial standpoint, transplantation is a much better option than years of dialysis," said Stanley C. Jordan, M.D., director of the Division of Nephrology and medical director of the Renal Transplant Program at Cedars-Sinai. The senior author of the journal article, Jordan developed high-dose intravenous immunoglobulin (IVIG) therapy to "desensitize" highly sensitized patients and increase their chances of successful transplantation. The approach became a Medicare-approved therapy in 2004 at the conclusion of a National Institutes of Health-funded multicenter study.
Cedars-Sinai is a national leader in desensitization for the highly HLA sensitized patient, offering therapy for those awaiting both living-donor and deceased-donor transplantation.
The New England Journal article describes a Phase I/II safety and limited efficacy trial of a combination of IVIG and rituximab, a monoclonal antibody - an antibody engineered to bind to a specific protein. The combination of IVIG and rituximab appears to offer superior benefits to IVIG alone, improving transplant rates to 80 percent of treated patients. The one-year patient and graft survival rates were 100 percent and 94 percent, respectively.
Based on these results, the new protocol is less costly than IVIG alone yet appears to be highly effective in reducing antibody levels and improving transplantation rates. Larger, multicenter trials are necessary to confirm these findings.
Because nearly one-third of kidney failure patients are highly sensitized and few transplant centers specialize in desensitization therapy, many potential candidates are told that a transplant simply is not possible.
"Patients who are on dialysis and those who are progressing toward renal failure should be considered for a kidney transplant. Ideally, they would be referred to a transplant center for evaluation even before they start dialysis because data show that those who get transplanted before starting dialysis do better," Jordan said. "However, for the highly sensitized patient, transplantation is not an option unless desensitization therapies are used."
Jordan estimates that about 40 percent of Cedars-Sinai's kidney transplant patients are highly sensitized and are referred or self-referred to the program because of their highly sensitized state. For many patients, especially those awaiting a deceased-donor transplant, the combination of IVIG and rituximab appears to offer an alternative to ongoing dialysis.
The New England Journal of Medicine article is accompanied by an editorial written by Ron Shapiro, M.D., of the Thomas E. Starzl Transplantation Institute at the University of Pittsburgh. He concludes his comments by saying, "As the authors note, their observations need to be confirmed and validated by other centers and in larger numbers of patients and during longer periods of follow-up. However, their approach may represent a breakthrough in the care of sensitized patients awaiting transplantation and may have the potential to help thousands of patients who are languishing on waiting lists around the world."
Cedars-Sinai Medical Center
Kidney Transplant News and Current Kidney Transplant Events RSSTrapping white blood cells proves novel strategy against chronic viral infections
Seeing disease-fighting white blood cells vanish from the blood usually signals a weakened immune system. But preventing white blood cells' circulation by trapping them in the lymph nodes can help mice get rid of a chronic viral infection, researchers at Yerkes National Primate Research Center and the Emory Vaccine Center have found.
Trapping white blood cells proves novel strategy against chronic viral infections
Seeing disease-fighting white blood cells vanish from the blood usually signals a weakened immune system. But preventing white blood cells' circulation by trapping them in the lymph nodes can help mice get rid of a chronic viral infection, researchers at Yerkes National Primate Research Center and the Emory Vaccine Center have found.
NewYork-Presbyterian/Columbia leads research into robotic surgery for kidney cancer
Clinical research at NewYork-Presbyterian Hospital/Columbia University Medical Center is helping bring the advantages of robotic surgery, including reduced pain and quicker recovery, to kidney cancer patients.
'Statins' linked to improved survival in kidney transplant recipients
For patients receiving kidney transplants, treatment with cholesterol-lowering "statin" drugs may lead to longer survival, reports a study in the November 2008 Journal of the American Society of Nephrology (JASN).
Kidney transplants less successful at night
Kidney transplants should be carried out during the day if possible. At least this is the conclusion suggested by a survey just published by urologists and internists at the University of Bonn.
Immune molecule that plays a powerful role in avoiding organ rejection identified
When a mouse's immune system is deciding whether to reject a skin graft, one powerful member of a molecular family designed to provoke such a response can effectively reduce the visibility of the mouse's own cells and help the graft survive, researchers say.
Drug may prolong organ life in noncompliant kidney transplant patients
New research from the University of California, San Diego Department of Medicine, Division of Nephrology, shows that the anti-rejection drug sirolimus (brand name Rapamune) may help prolong the clinical benefit of transplanted kidneys and delay rejection, especially in patients who do not regularly take their prescribed medications (are "non-compliant").
Anti-rejection drug may increase risk of diabetes after kidney transplant
For patients undergoing kidney transplantation, treatment with the anti-rejection drug sirolimus may lead to an increased risk of diabetes, reports a study in the July Journal of the American Society of Nephrology (JASN).
Hidden heart condition increases the risk of death in patients waiting for kidney transplants
An often asymptomatic condition-systolic dysfunction, or decreased pumping of the heart-poses an increased risk of death for patients on kidney transplant waiting lists, according to a study appearing in the June 2008 issue of the Journal of the American Society Nephrology (JASN).
UCSF marks a milestone with 500th transplant in heart and lung program
UCSF marked a milestone this week with the 500th procedure in its Thoracic Transplant Program, which specializes in transplantation of the heart and lung.
More Kidney Transplant News Articles
 | Handbook of Renal Biopsy Pathology by Alexander J. Howie This handbook provides a short, clear, useful and interesting guide to the findings in renal biopsy specimens. It is intended to be of practical help primarily to pathologists and trainee pathologists who look at these specimens, but also to nephrologists and transplant surgeons and their trainees, medical students, and others who have contact with anyone with renal disorders, including nurses on... |
 | Dropsy, Dialysis, Transplant: A Short History of Failing Kidneys (Johns Hopkins Biographies of Disease) by Steven J. Peitzman Small and bean shaped, the kidneys are sophisticated organs that filter waste from the blood. A number of diseases and disorders -- including diabetes and hypertension -- can harm the kidneys and cause them to fail.Historian and nephrologist Steven J. Peitzman traces the medical history of kidney disease alongside the personal experience of illness. Drawing on diaries, letters, literary... |
 | Kidney for Sale by Owner: Human Organs, Transplantation, and the Mark by Mark, J Cherry During the past ten years over 4,600 people have died annually in the United States while waiting for organ transplants. In 2003, 83,000 patients waited for transplantation--but only 20,000 patients received them. While everyone seems to agree that this is a national tragedy, bold initiatives to address the problem--such as creating a fee-based and regulated market for organ transplantation--have... |
 | A Fragile Life: The Epic of a Multiple Kidney Transplant Recipient by Guy M. Hollingsworth A Fragile Life: The Epic of a Multiple Kidney Transplant Recipient is an in-depth effort to understand living with a chronic illness (specifically kidney disease) as perceived by a woman who is a wife and a mother, covering the years from 1982 to 2005, and her efforts to address challenges associated with this illness.Christine has weathered multiple losses over a 23-year period due to kidney... |
 | Kidney Transplantation: Principles and Practice by Peter Morris, Stuart J. Knechtle Updated to reflect todays practice guidelines, the new edition of this comprehensive text remains the definitive resource on all aspects of renal transplantation, including immunological, pathological, psychological and ethical considerations. It examines evaluation, management, and procurement of living and deceased donor kidneys, the selection of suitable recipients, interpretation of graft... |
 | Perfect Match: A Kidney Transplant Reveals the Ultimate Second Chance by Janet Hermans |
 | The Roller Coaster Decade by Livia Moser The Roller Coaster Decade is an autobiography of 10 years of my life which begins when I was eighteen years old. I like all other high school graduates had plans for my life, but sometimes life just doesn't work out that way. I was diagnosed with bipolar illness and put into a mental facility in Switzerland, therefore having to postpone... |
 | Handbook of Kidney Transplantation A practical overview of renal transplantation for physicians who manage transplant patients as well as nurses and other professionals on the transplant team. The Second Edition has been thoroughly revised with completely up-to-date coverage of topics such as immunosuppressive drugs, short- and long-term post-transplant management and complications, and ethical/legal... |
 | George M. Abouna: The History of a Pioneer in Transplant Surgery by Samir Johna This is the true story of a man who rose from the depth of poverty to become a pioneer in modern medicine. Born in a small village in Iraq, and raised by a poor family, he met and conquered many adversities in his pursuit of a better living and his goal of becoming a physician. His chosen path was briefly derailed when he was granted a full scholarship to study engineering in United Kingdom, but... |
 | Kidney Transplants Explained by Andy Stein, Rob Higgins, Janet Wild |
| © 2008 BrightSurf.com |