Credit: Tareq Salahuddin
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.
Now, a study that experts have described as “revolutionary” shows that a transplant from an incompatible donor saves many lives. Just last week 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.
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.
Waiting for a Kidney Transplant
Of this number, about 110,000 people in the United States are on the waiting list for a kidney transplant, but about one-third of them have antibodies against human leukocyte antigens, HLAs, that will attack a transplanted kidney. Many of them stay 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.
“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.”
There is an added cost, but it is “relatively small,” Dr. Segev says. 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 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.
This article is based on an earlier version of my article published by HealthCentral.
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