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Successful kidney transplant despite tissue intolerance

The working group around Doctor Christian Morath, senior physician at the kidney center of the Medical University Clinic Heidelberg and Professor Caner Süsal, head of the antibody laboratory at the University Clinic Heidelberg, showed in a study on 34 sensitized high-risk patients that the success rate of these patients does not differ from the success rate with low immunological risk is different; after one year, around 95 percent of the grafts were still working. The Heidelberg scientists have developed a therapy concept especially for this group of high-risk patients.

When the kidneys stop working, patients either go on dialysis or are given a donor kidney. The blood group and tissue compatibility characteristics (HLA characteristics) of the donor and recipient should match as closely as possible. Since the recipient organism always tries to reject the foreign organ, even with the same HLA characteristics, patients have to take immunosuppressive drugs for life after the transplantation.

For several years, researchers from the Heidelberg Department of Transplant Immunology collected data in the world's largest database on kidney transplants (Collaborative Transplant Study) in order to identify immunological high-risk patients. Such patients, for example, have developed antibodies against foreign tissue characteristics after pregnancy and therefore have little chance of receiving a donor organ for which the tissue match test is directly negative.

“The risk that the transplanted organ will be rejected soon after the operation is particularly high for them. High-risk patients can only be successfully transplanted with additional measures, ”explains Süsal.

In the study, 34 immunological high-risk patients received plasmapheresis or immunoadsorption (existing antibodies are removed from the blood of the organ recipient) before and after transplantation of the donor kidney from a brain-dead (28) or living donor (6). In addition, the patients were given rituximab, which destroys the cells that could produce new antibodies. With the help of intensified immunosuppression and close monitoring of possible rejection reactions, around 95 percent of the transplanted kidneys were still functional after one year.

MEDICA.de; Source: Heidelberg University Hospital