• DOI:10.1056/NEJMoa1012376
• Corpus ID: 22115880

Desensitization in HLA-incompatible kidney recipients and survival.

@article{Montgomery2011DesensitizationIH,
  title={Desensitization in HLA-incompatible kidney recipients and survival.},
  author={Robert A. Montgomery and Bonnie E. Lonze and Karen Eileen King and Edward S. Kraus and Lauren M. Kucirka and Jayme E. Locke and Daniel S. Warren and Christopher E. Simpkins and Nabil N. Dagher and Andrew L. Singer and Andrea A. Zachary and Dorry L. Segev},
  journal={The New England journal of medicine},
  year={2011},
  volume={365 4},
  pages={
          318-26
        }
}

• R. Montgomery, B. Lonze, +9 authors D. Segev
• Published 27 July 2011
• Medicine, Biology
• The New England journal of medicine

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 live-donor 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 dialysis-only group and rates of 93.1%, 77.0%, 65.6%, and 49.1%, respectively, for patients in the dialysis-or-transplantation group (P<0.001 for both comparisons).

CONCLUSIONS
Live-donor transplantation after desensitization provided a significant survival benefit for patients with HLA sensitization, as compared with waiting for a compatible organ. By 8 years, this survival advantage more than doubled. These data provide evidence that desensitization protocols may help overcome incompatibility barriers in live-donor renal transplantation. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and the Charles T. Bauer Foundation.).