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Handling Rejection: Drugs, Treatment Boost Transplant Survival

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WebMD Health News

March 1, 2000 (Boston) -- Like actors and writers, people who receive organ transplants learn to live with the possibility of rejection. But for kidney transplant recipients, the risk of organ rejection has significantly diminished since the 1980s with advances in medication and treatment, report authors of two studies published in the March 2 issue of The New England Journal of Medicine.

In one study, researchers analyzed all kidney transplants performed in the U.S. between 1988 and 1996 -- nearly 94,000 of them -- and estimated the risk of rejection within the first year, and also at more than one year after transplantation.

In 1988 a drug called cyclosporine was still the new kid on the block. Cyclosporine helps give the body a chance to accept the new kidney by fighting inflammation brought on by the immune system's natural response to the foreign organ.

Back then, nearly 13% of kidneys received from a living donor were rejected and approximately 25% of kidneys from recently dead donors failed within one year. But by 1996, nearly 94% of all kidneys taken from live donors made it to their first transplant anniversary, as did 88% of those taken from dead donors. During this time, the average survival time of kidneys from living donors grew steadily from 12.7 years to 21.6 years, and kidneys from dead donors also enjoyed a near doubling in life-span -- from 7.9 to 13.8 years, reports Sundaram Hariharan, MD, and the other authors.

"This study has clearly documented that reduction in the rejection rate has not only had an impact on the one-year [kidney] survival [rate], but also an impact on long-term survival," says Hariharan, associate professor of medicine and nephrology at the Medical College of Wisconsin, Milwaukee, in an interview with WebMD.

A second study added another favorable chapter to the continuing success story of transplant survival. In trials involving the drug daclizumab in 55 patients undergoing a first heart transplant, those who received the drug -- which helps fight inflammation by blocking a specific immune reaction -- had a significantly lower incidence of rejection than patients treated with general immune system suppressing drugs alone.

In addition, people who had received daclizumab were much more likely to have a functioning heart after the transplant procedure than the other patients were, report Ainat Beniaminovitz, MD, and colleagues at Columbia-Presbyterian Medical Center in New York.

But new drugs alone can't account for improved transplant survival rates, says Charles B. Carpenter, MD, professor of medicine at Harvard University School of Medicine and senior physician at Brigham and Women's Hospital in Boston, who wrote an editorial accompanying the studies. Carpenter points out that progressive increases in transplant survival over the last several years took place in the era of multiple drugs like cyclosporine and immune-suppressing steroids.

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