Desensitization in HLA-incompatible kidney recipients and survival

Robert A. Montgomery, Bonnie E. Lonze, Karen Eileen King, Edward Kraus, Lauren M. Kucirka, Jayme E. Locke, Daniel Warren, Christopher E. Simpkins, Nabil N. Dagher, Andrew L. Singer, Andrea A. Zachary, Dorry Segev

Research output: Contribution to journalArticle

Abstract

BACKGROUND: More than 20,000 candidates for kidney transplantation in the United States are sensitized to HLA and may have a prolonged wait for a transplant, with a reduced transplantation rate and an increased rate of death. One solution is to perform livedonor renal transplantation after the depletion of donor-specific anti-HLA antibodies. Whether such antibody depletion results in a survival benefit as compared with waiting for an HLA-compatible kidney is unknown. METHODS: We used a protocol that included plasmapheresis and the administration of low-dose intravenous immune globulin to desensitize 211 HLA-sensitized patients who subsequently underwent renal transplantation (treatment group). We compared rates of death between the group undergoing desensitization treatment and two carefully matched control groups of patients on a waiting list for kidney transplantation who continued to undergo dialysis (dialysis-only group) or who underwent either dialysis or HLA-compatible transplantation (dialysis-or-transplantation group). RESULTS: In the treatment group, Kaplan - Meier estimates of patient survival were 90.6% at 1 year, 85.7% at 3 years, 80.6% at 5 years, and 80.6% at 8 years, as compared with rates of 91.1%, 67.2%, 51.5%, and 30.5%, respectively, for patients in the dialysisonly group and rates of 93.1%, 77.0%, 65.6%, and 49.1%, respectively, for patients in the dialysis-or-transplantation group (P

Original languageEnglish (US)
Pages (from-to)318-326
Number of pages9
JournalNew England Journal of Medicine
Volume365
Issue number4
DOIs
Publication statusPublished - Jul 28 2011

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ASJC Scopus subject areas

  • Medicine(all)

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