Making Kidney Transplants Possible for More Patients
Apr 02, 2017 Cedars-Sinai Staff
Tens of thousands of patients in the US are waiting for kidney transplants, and more than a quarter of them have an elevated risk of their bodies rejecting the transplant because of a certain protein in their immune system.
These patients often end up on dialysis indefinitely.
Cedars-Sinai researchers have developed a treatment that makes kidney transplants safer and more effective for these patients, making it more likely they'll be able to get a transplant and get off dialysis.
"Somewhere between 25% to 30% of patients on the national kidney transplant list could benefit from this therapy," says Dr. Stanley C. Jordan, director of the Kidney Transplant Program. "Certainly if we can get people off dialysis with a kidney transplant, it’s the best therapy we can give them for long-term survival."
The human leukocyte antigen—or HLA—system is a group of proteins that regulate how the body recognizes foreign substances. Organ transplant patients who are HLA-sensitized have developed antibodies to the potential kidney donor's HLA. This means that the patient's immune system would attack the cells in the new kidney, leading to the organ’s failure.
Researchers led by Jordan are addressing this problem with an innovative treatment known as IVIG therapy. Offered within the Kidney and Pancreas Transplant Center, IVIG and the Transplant Immunotherapy Program have vastly improved the lives of people who once had to remain on dialysis indefinitely.
That's a breakthrough worth celebrating this April during National Donate Life Month, the nationwide awareness program that encourages people to register as organ, eye, and tissue donors.
What causes sensitization?
Tissue compatibility is an issue for all patients receiving transplanted organs. The risk of rejection rises dramatically for those with a high exposure to HLAs. This exposure results from:
- Blood transfusions.
- A previous transplant.
- Pregnancy. The mother is exposed to the father’s antigens, which are expressed in the cells of the developing baby.
If a person has become highly sensitized, their immune system is hyper-vigilant to invaders—even when the invader is a lifesaving transplanted organ.
The process of IVIG therapy
"We do know that our desensitization protocols save lives when we transplant patients," Dr. Jordan says of IVIG, which stands for intravenous immunoglobin. These proteins are natural defenses against invading organisms.
IVIG is a form of immunoglobin made from blood plasma. Given to patients via injection, IVIG therapy reduces HLA sensitivity by adding helpful antibodies to the bloodstream. This lowers the level of HLA antibodies and blocks their ability to attack a transplanted organ.
Many anti-rejection therapies suppress the entire immune system, making patients more susceptible to infections. But IVIG actually enhances a patient’s protection against infection, further increasing the likelihood of a successful transplant.