Desensitization Shows Survival Benefit in Kidney Transplant Candidates

For HLA-sensitized patients awaiting a kidney transplant, desensitization therapy followed by HLA-incompatible kidney transplantation leads to better survival than continued waiting for a compatible organ, reports a study published in the New England Journal of Medicine.

The study included a “treatment group” of 211 HLA-sensitized patients who received an HLA-incompatible living donor kidney after undergoing desensitization treatment with plasmapheresis and low-dose intravenous immune globulin from 1998 through 2009. They were carefully matched to patients who continued to receive dialysis or who underwent dialysis or HLA-compatible kidney transplantation.

The Kaplan-Meier estimated survival for patients undergoing desensitization therapy was 90.6 percent at 1 year, 85.7 percent at 3 years, and 80.6 percent at both 5 and 8 years. This was significantly higher than for the “dialysis-only” control individuals, for whom survival was 91.1 percent at 1 year, 67.2 percent at 3 years, 51.5 percent at 5 years, and 30.5 percent at 8 years. It was also superior to the “dialysis-or-transplantation” group: 93.1, 77.0, 65.6, and 49.1 percent, respectively. Desensitization was linked to better survival at all levels of donor-specific anti-HLA antibody.

For HLA-sensitized patients, depletion of donor-specific antibodies may allow timely living donor kidney transplantation as an alternative to remaining on the waiting list. The new study suggests that desensitization therapy provides a significant survival advantage compared with continued dialysis or later HLA-compatible kidney transplantation. “By 8 years, this survival advantage more than doubled,” the researchers write [Montgomery RA, et al. Desensitization in HLA-incompatible kidney recipients and survival. N Engl J Med 2011; 365:318–326].

September 2011 (Vol. 3, Number 9)