A new study has shown that a kidney transplant from an incompatible donor could be successful by desensitizing the immune system response. These findings could be revolutionary in prolonging the lives of people with compromised kidneys.
Kidney failure is one of the most devastating complications of uncontrolled diabetes. A kidney transplant is the best hope for long-term survival, but finding a compatible donor is almost impossible for some people whose kidneys have failed.
On March 10, 2016, The New England Journal of Medicine published a long-term study of more than 1,000 transplants of incompatible kidneys that were performed in the past few years at 22 centers. While only the abstract of the study is online, the lead author Dorry Segev, MD, PhD, associate professor of surgery at the Hopkins School of Medicine, sent me the full text upon my request, allowing me to learn all the details and provide an analysis of how exactly the findings relate to people living with diabetes**.**** The current landscape of kidney transplants and who is affected**
Almost half a million people in the United States are on dialysis due to end-stage renal disease, which is chronic and irreversible kidney failure. By far the greatest proportion of them, about 44 percent, have diabetes, according to the most recent annual report of the National Institute of Diabetes and Digestive and Kidney Diseases.
Of this number, about 110,000 people in the United States are on the waiting list for a kidney transplant. About one-third of those people have antibodies against human leukocyte antigens, HLAs, a response from the immune system that will attack a transplanted kidney as a foreign entity. Many end up staying on dialysis and remain on the waiting list until they die without ever finding a suitable donor.
But Dr. Segev and his associates found that eight-year survival rates were almost 77 percent for people who received an HLA-incompatible kidney from a live donor. By comparison, the eight-year survival rates for people who remain on dialysis are 44 percent and 63 percent for people who remained on a waiting list for a kidney or received a kidney from a deceased donor.
What makes these transplants a success? By tweaking the immune system’s response to the new kidney, the body becomes more accepting of the donor’s organ and the new kidney is allowed to function properly.
“The implications of these results are revolutionary,” write Drs. Lionel Rostaing and Paolo Malvezzi of the Centre Hospitalier Universitaire Grenoble Alpes in La Tronche, France, in an editorial accompanying the study. Using incompatible kidneys from living donors “may save lives and may be cost effective over time.”
Desensitizing the immune system of each patient to accept the incompatible kidney and drugs to keep the immune system from rejecting it can add between $10,000 and $20,000. This is an added cost, but it is “relatively small,” Dr. Segev says. This is in addition to the $100,000 cost of a transplant itself.
The costs of dialysis
But, he says, compared to the cost of $100,000 a year for dialysis, a transplant quickly becomes cost effective over time. Dialysis, of course, can also be stressful and time-consuming for people who need it.
Like essentially everyone who has diabetes, I have no idea whether my immune system has antibodies against HLAs. I don’t expect that any of us are in a hurry to know if we have these antibodies, but it’s good news to learn that this is no longer an insurmountable barrier to a successful kidney transplant.
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David Mendosa was a journalist who learned in 1994 that he had type 2 diabetes, which he wrote about exclusively. He died in May 2017 after a short illness unrelated to diabetes. He wrote thousands of diabetes articles, two books about it, created one of the first diabetes websites, and published a monthly newsletter, “Diabetes Update.” His very low-carbohydrate diet, A1C level of 5.3, and BMI of 19.8 kept his diabetes in remission without any drugs until his death.