Kidney Transplant From Incompatible Living Donor
Study finding offers hope to patients who might die while on the wait list for a compatible deceased donor
By Amy Norton
WEDNESDAY, March 9, 2016 (HealthDay News) -- In what experts call a possible "paradigm shift," a new study shows kidney disease patients may live far longer if they receive a transplant from an incompatible living donor rather than wait for a good match.
The findings could offer another choice for kidney patients who might otherwise die waiting for a compatible deceased donor.
Specifically, experts said the results offer hope to "highly sensitized" transplant candidates.
That refers to patients who have a large number of immune system antibodies ready to attack a donor organ. It's common among people who've had a prior kidney transplant, according to the United Network for Organ Sharing. Patients who have had multiple blood transfusions while on dialysis, or who have been pregnant several times, can also become sensitized.
Finding a compatible donor for sensitized patients is "nearly impossible," said study lead researcher Dr. Dorry Segev, an associate professor of surgery at Johns Hopkins University School of Medicine, in Baltimore.
An alternative is to transplant a kidney from an incompatible donor, with the help of special "desensitization" therapies that reduce the risk of an immune system attack on the donor organ.
Johns Hopkins pioneered the approach 15 years ago, and other transplant centers have followed suit.
Only now, though, is the long-term benefit becoming clear. Using data from 22 U.S. hospitals, Segev's team found that more than three-quarters of patients who received a kidney from an incompatible living donor were still alive eight years later.
"This is potentially a paradigm shift," said Dr. Michael Flessner, a program director in the division of kidney, urologic and hematologic diseases at the U.S. National Institute of Diabetes and Digestive and Kidney Diseases, which funded the study.
Flessner expects incompatible living-donor transplants will become standard practice.
Such donations are not a panacea: There is a higher risk of rejection than with transplants from compatible living donors, said Dr. Harold Helderman, a professor of medicine at Vanderbilt University Medical Center, in Nashville.
And because patients receive especially powerful immune-system suppressing drugs, they can be at increased risk for infections, he noted.