Major Cause of Kidney Transplant Failure has been Identified and Corrected

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Kidney Transplant patients who develop anti-HLA antibodies (proteins on the surface of white blood cells and other tissues) may be at particularly high risk of having their Kidney Transplant fail within a few years, a September 26th, 2013 New England Journal of Medicine study suggests. If a kidney donor's HLAs do not fully match a recipient's, the recipient's immune system will develop anti-HLA antibodies and in some cases those antibodies may attack and severely injure the donor kidney while in others, they may do little to no damage. "What we've been grappling with is, what is a 'relevant' antibody?" Dr. Jacqueline Lappin said.

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Based on the new findings, the anti-HLA antibodies that are a problem can be distinguished by whether they bind to an immune system protein (C1q). CKD patients with C1q-binding antibodies were at much higher risk of having the donor kidney fail because C1q is key in activating the part of the immune system that helps antibodies fight foreign invaders (complement system) such as a Transplanted Kidney.

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The results may help pinpoint those who are at the highest risk of a transplant failure by measuring the "complement-binding" capacity of anti-HLA antibodies and possibly aid in finding a better kidney donor match, experts believe. In the studied group, only 54% of people with CKD had a kidney that survived for five years while about 94% of transplants survived in those with either no anti-HLA antibodies or anti-HLA antibodies that did not bind to C1q.

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About 30% of people who need a donor kidney have a high level of anti-HLA antibodies (sensitized) as a result of past exposure to foreign tissue due to a prior Kidney Transplant, blood transfusion or pregnancy. It is estimated that sensitized individuals with CKD wait three to four times longer for a compatible kidney from a deceased donor when compared to non-sensitized patients.

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Dr. Lappin said the new results could potentially give sensitized patients more options to receive a kidney and have it last longer. These include filtering antibodies from the blood in a process called plasmapheresis; or treatment with medications like intravenous immunoglobulin (used currently for the treatment of autoimmune or inflammatory diseases). Also, Lappin noted that the finding presents a possibility where if patients' have a high level of antibodies but are not of the C1q-binding variety, a donor kidney could still be a suitable match and the CKD patient will not be immediately disqualified from transplantation. believes that this is good news because it increases the chances of receiving and keeping a Kidney Transplant for the 98,000 people in the United States who are currently waiting for a kidney.

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Reference: "Finding May Help Doctors Pinpoint Likelihood of Kidney Transplant Failure." Newsday.