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    Handling Rejection: Drugs, Treatment Boost Transplant Survival


    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.

    "What the study [by Hariharan and others] does not address are the possible contributions of better clinical care," such as better treatment of high blood pressure, more effective treatment and prevention of serious infections, and an increased use of better-matched kidneys from recently dead donors, according to Carpenter.

    Carpenter tells WebMD that in spite of the improvements in kidney transplants in the last several years, a significant shortage of available organs still exists. Many patients still have to stay on kidney dialysis machines and some even die from kidney failure while waiting for an acceptable kidney.

    Improving the care of patients after receiving a kidney transplant, combined with current or future anti-rejection therapies, could partially ease the current organ shortage, he says.

    "We're in a bear market," Carpenter says. "Every year we get further behind and it keeps going down." Doubling the survival time of transplanted kidney through better use of immune-suppressing drugs would be "virtually the same as doubling the donor supply."

    • Today's kidney and heart transplant patients have a better chance of avoiding rejection of their new organs, compared to patients in the 1980s.
    • Drugs such as cyclosporine for kidney recipients and daclizumab in heart transplant patients have significantly boosted the survival of the new organs.
    • Observers note drugs should not get all the credit, however, as doctors today are more skilled in controlling blood pressure and infection as well as in getting better-matched organs. All together, these improvements help reduce the number of treatment failures, which eases the overwhelming demand to provide new organs to so many sick patients.
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