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Densensitization Procedure Helps Hard-to-Match Kidney Recipients
Date:7/27/2011

se the body to develop antibodies (become sensitized) to HLA. This can happen during pregnancy, a blood transfusion or previous transplantation. If exposed to that particular foreign antigen again, the HLA antibodies will destroy any tissue containing it. This severely limits the number of eligible transplant donors for a recipient who is sensitized.

In an attempt to overcome this significant problem, Montgomery and his colleagues began recruiting HLA-sensitized potential kidney transplant recipients. From 1998 through 2009, the researchers treated 211 HLA-sensitized people waiting for transplants with the desensitization procedure. More than half of this group had already had one kidney transplant.

Plasmapheresis works much like dialysis. In dialysis, blood is removed from the body, filtered to remove waste and returned to the body, newly purified. In plasmapheresis, the blood is separated to remove the plasma, which contains the antibodies. The remaining portion of the blood is returned to the body along with plasma donated from a healthy person. Because this process removes antibodies, it can leave people vulnerable to infection. To combat this potential side effect, the researchers gave small doses of the immune-boosting drug IVIG.

The HLA-sensitized patients received an average of four plasmapheresis sessions before transplant and five after transplant, according to the study.

The researchers compared these patients to two other groups of matched control subjects. One group stayed on dialysis, while the other group either stayed on dialysis or had an HLA-compatible transplant.

During the first year after transplant, survival rates were similar among the three groups. After three years, the survival rate was 85.7 for the desensitized group compared to 67.2 percent in the dialysis-only group and 77 percent for the dialysis or transplantation group.

By five years, estimates of patient survival were 81 percent for the desensi
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