Crossing the HLA Barrier: HLA-Desensitisation and Renal Transplantation
HLA-sensitisation is observed in 30% of patients on the kidney-transplant waiting list and has long been a problem in transplantation treatment of kidney failure. In this study conducted across the UK, Germany and the Netherlands, Montgomery et al investigate the possibility of overcoming this obstacle to successful lasting treatment of renal failure.
Published last month in the New England Journal of Medicine, the paper compares its method of overcoming the presence of donor-specific HLA antibody and subsequent transplantation (treatment group) to dialysis treatment (dialysis group). To achieve desensitisation, participants in the treatment arm underwent plasmapheresis at least twice after transplantation with non-HLA-compatible kidneys. Over a period of 8 years there was a significant increase in survival rate estimates of the treatment group as compared to the dialysis group (80.6% as compared to 30.5%). The study concludes that transplantation subsequent to HLA-desensitisation is associated with better outcomes, patients no longer requiring a completely negative cross-match for the treatment.
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