Desensitization in HLA-incompatible kidney recipients and survival

Area of Science:

• Nephrology
• Immunology
• Transplantation Science

Background:

• Over 20,000 US kidney transplant candidates have HLA sensitization, leading to longer waits and higher mortality.
• Live-donor renal transplantation after anti-HLA antibody depletion is a potential solution.
• The survival benefit of this antibody depletion strategy versus waiting for a compatible kidney remains unestablished.

Purpose of the Study:

• To evaluate the survival benefit of desensitization protocols in HLA-sensitized kidney transplant candidates.
• To compare outcomes between patients undergoing desensitization and HLA-sensitized patients on dialysis or awaiting compatible transplants.

Main Methods:

• A desensitization protocol involving plasmapheresis and intravenous immune globulin was used for 211 HLA-sensitized patients.
• Patient survival rates were compared between the desensitization treatment group and two control groups (dialysis-only and dialysis-or-transplantation).
• Careful matching of control groups ensured comparability with the treatment cohort.

Main Results:

• The desensitization group showed significantly higher patient survival rates at all time points compared to both control groups (P<0.001).
• At 8 years post-transplant, survival was 80.6% in the desensitization group versus 30.5% (dialysis-only) and 49.1% (dialysis-or-transplantation).
• The survival advantage in the desensitization group more than doubled by the 8-year mark.

Conclusions:

• Live-donor kidney transplantation following desensitization offers a substantial survival benefit for HLA-sensitized patients.
• Desensitization protocols effectively overcome HLA incompatibility barriers in renal transplantation.
• These findings support the implementation of desensitization strategies to improve outcomes for sensitized transplant candidates.