BACKGROUND: About one-third of kidney patients are often told they cannot have a transplant even if they have a donor with an otherwise perfectly matched tissue and blood type. Their anti-donor antibody levels are so high that any transplanted organ would be rejected by their highly sensitized immune system. Now there is a specialized type of anti-rejection therapy using intravenous immunoglobin (IVIG), which injects antibodies from healthy people into the blood supply, to modulate the immune system without suppressing it. This makes kidney transplant possible for as much as 25-30% of this group of patients, who would otherwise not be eligible for a transplant because of their high antibody levels.
DEALING WITH REJECTION: Tissue compatibility is an issue for all patients receiving organ transplants, but rejection risks are much higher for those with high exposure to human leukocyte antigens (HLAs) that are not produced by their own bodies. Exposure may be the result of blood transfusions, previous transplantation, or even pregnancy if the mother is exposed to the father's antigens, which are then expressed in the cells of the developing fetus. The immune system is then 'sensitized' to those antigens -- primed with antibodies that attack any foreign tissue, even if the antigens arrive in the form of a life-saving donated organ.
ABOUT IVIG: IVIG modulates the immune system without suppressing it. In fact, the therapy actually boosts the immune system because the antibodies found in IVIG help fend off infections -- a common post-surgery complication. For the most highly sensitized patients, IVIG is combined with a new drug, Rituxan, which reduces treatment time from four months to one before transplantation. The therapy can be used in both living-donor and cadaver-donor transplants. In the late 1980s. Dr. Stanley C. Jordan pioneered the use of IVIG as a way to reduce organ rejection among highly sensitized patients. It is now a fully accepted, Medicare-approved therapy as of 2004, when it was found to be effective in a multi-center study partly funded by the National Institutes of Health.
WHAT IS DIALYSIS? Hemodialysis is a treatment for end stage renal disease (ESRD), or kidney failure, in which blood is removed from the body, filtered through an artificial kidney and then the cleaned blood is returned to the body. In the US, hemodialysis is the most common treatment for people who have kidney failure. However, dialysis is also a painful, expensive procedure, and while it cleans the blood well enough to maintain existence, it does little to improve a patient's overall quality of life. Also, data shows that if patients get a transplant before they get to the point of dialysis, they do better in the longer term.