I hope this was front page news in the print edition. This is a truly revolutionary breakthrough that could save thousands of lives.
4
I have a dear friend who spends 4-5 hours three times a week on dialysis. I have offered him one of my kidneys...now it looks like there is a possibility that more donations can be made and more people can get off dialysis.
Hallelujah!
Hallelujah!
3
Similar research has been done with bone marrow transplants, where the recipient's immune system is wiped and replaced by the marrow donor's. It's possible that desensitizing removes the template for white blood cells in the patient's bone marrow and the replacement antibodies provide a new template for bone marrow to use, without the invasiveness of a marrow transplant.
Real heroes are the guys that do this research every day. Not artists, or politicians or sportspeople... Sometimes we should reconsider and redirect our admiration.
5
Irony of all ironies, Dr. Paul Terasaki who engineered the tests and computerized typing to match donor organs with recipients for virtually all the successful transplants "died on the list" because of his age. This might have saved him for many more contributions to the world.
3
My husband has been on peritoneal dialysis for 10 years. After a failed transplant 9 years ago, his antibodies are very high. He is very hard to match. His brother would like to donate but it requires the desensitization therapy. We switched from Einstein to Jefferson Hospital in Philly because at that point they offered the desensitization therapy. After we went through all their testing & all, now, they don't offer it. And now I can't seem to find another hospital (that takes my insurance) in the area that does it. How can that be? Philly, I thought was on the cutting edge of medical breakthroughs. Guess not. We could go to John Hopkins but that not covered by my insurance, will cost us at a minimum of $20,000.00. And since I have like $350.00 in my checking acct, don't think I can cover that. On the other hand, how much is my husband's life worth?
4
Wonderful news -- this is the most important story in the paper today.
2
I just wish this could be an example of the running commentary we are exposed to every day and not what is typically above the fold most days. What really terrific news.
1
This sounds very positive. This could be the medical break through that I need to be healthy again. Way to go.
2
This is very interesting. I wonder if this procedure could be adapted to modify a person's immune system to mitigate or cure an autoimmune disease such as multiple sclerosis or inflammatory bowel disease. In both cases, organ transplant and various autoimmune diseases, the person's immune system is attacking parts of the body.
Any thoughts?
Any thoughts?
4
Can the desensitization take place after transplantation? Say an individual who was doing fine but developed host-graft problems later?
Glad to see this development, it will really change kidney transplantation.
Glad to see this development, it will really change kidney transplantation.
3
I'm a kidney transplant patient from '02 with a different protocol that also eliminated the immune system before putting in the kidney so it wouldn't reject.
Even with hemo-dialysis, one is kept half-alive with chemical depression a constant struggle. Peritoneal is better if you can do it but it is still a long ways from a normal life. Hooray for breaking down the barriers to effective transplants.
Even with hemo-dialysis, one is kept half-alive with chemical depression a constant struggle. Peritoneal is better if you can do it but it is still a long ways from a normal life. Hooray for breaking down the barriers to effective transplants.
4
Wonderful. But saying ''dialysis is not a life'' is not respectful of those patients who have made a good life form dialysis.
3
Oh my goodness, this article honestly made my jaw drop. I am a transplant recipient going on nine years with my sister's kidney. A few months ago, a biopsy suddenly revealed that I was undergoing acute antibody-mediated rejection - my body was suddenly attacking the kidney (still working as good as new itself). Nine days in-hospital thankfully helped stem the antibody tide with a combo of immunoglobin/steroidal treatment and plasmapheresis (basically a less invasive, temporary dialysis of the body's plasma).
Kidney is doing well again, but this rejection episode further emphasized for me that the clock is always ticking. If this procedure ends up being commonly adopted...well! I have not felt this hopeful in such a very long time.
Kidney is doing well again, but this rejection episode further emphasized for me that the clock is always ticking. If this procedure ends up being commonly adopted...well! I have not felt this hopeful in such a very long time.
10
Great news for transplant patients, families, and the amazing medical teams that take care of them.
While any opportunity to extend the viability of transplanted organs should be celebrated, how can this treatment meaningfully improve lung transplant outcomes?
Living lung donation is exceptionally rare. Virtually all transplanted lungs come from cadavers.
Lungs are constantly exposed to airborn germs, so they deteriorate faster than any other commonly transplanted organ. 5 years is the average survival rate after surgery for a lung transplant recipient.
The very few hospitals even willing to attempt a Partial Lung Lobe transplant from a living donor have largely stopped doing so because risks to the living donor's health are far greater than the benefit of only receiving a lobe is for a transplant recipient.
It is unclear here whether this treatment must evolve to assist lung transplants or lung transplants must first evolve to even benefit from a treatment limited to cadaver organs.
While any opportunity to extend the viability of transplanted organs should be celebrated, how can this treatment meaningfully improve lung transplant outcomes?
Living lung donation is exceptionally rare. Virtually all transplanted lungs come from cadavers.
Lungs are constantly exposed to airborn germs, so they deteriorate faster than any other commonly transplanted organ. 5 years is the average survival rate after surgery for a lung transplant recipient.
The very few hospitals even willing to attempt a Partial Lung Lobe transplant from a living donor have largely stopped doing so because risks to the living donor's health are far greater than the benefit of only receiving a lobe is for a transplant recipient.
It is unclear here whether this treatment must evolve to assist lung transplants or lung transplants must first evolve to even benefit from a treatment limited to cadaver organs.
This is good news, but potential kidney donors are still being turned away for economic reasons. If you cannot afford to take the needed time away from work, you are not allowed to be a donor. This is what I was told by a representative from a prominent Wisconsin transplant center, and it seems like a bad policy for everyone.
4
True. Common question: does the recipient have insurance to cover the procedure and the years of immunosuppressive therapy?
What we need to study and was not done is to compare someone who receives a transplant after being desensitized with someone who is sensitized and received a transplant from a paired exchange and wasn't desensitized. Many believe that a paired exchange is a better option. There are challenges with paired exchanges. This article discusses the issues: http://www.lkdn.org/LKDN_The_Paired_Exchange_Conundrum.pdf
It is important to know from the study that desensitization is seeing good success. I'd like to make 2 points about the studies conclusion:
1. This information is NOT a surprise. You would expect that someone who receives a transplant after being desensitized will be much better off than someone waiting and/or that is on dialysis.
2. Also, more info is needed when comparing someone who receives a transplant after being desensitized with someone who receives a deceased donor kidney. How much longer did someone have to wait to receive a deceased donor kidney? Transplant outcomes are not as successful the longer you are on kidney dialysis.
It is important to know from the study that desensitization is seeing good success. I'd like to make 2 points about the studies conclusion:
1. This information is NOT a surprise. You would expect that someone who receives a transplant after being desensitized will be much better off than someone waiting and/or that is on dialysis.
2. Also, more info is needed when comparing someone who receives a transplant after being desensitized with someone who receives a deceased donor kidney. How much longer did someone have to wait to receive a deceased donor kidney? Transplant outcomes are not as successful the longer you are on kidney dialysis.
1
I am a patient, from what I believe is the single center this 22 center study is based upon. Both of my transplants, which failed for reasons not related to these procedures, were only possible due to desensitization. I am currently awaiting a 3 transplant, and desensitization will be used again. Without the work of Dr. Jordan, Dr. Vo and their team no of this would have been possible. I'm happy to see that they have finally been able to get their work recognized on a grander scale! If you have ever considered donating a kidney PLEASE DO!!
3
Back in the 50's, a kidney transplant between identical twins was worldwide front-page news. In the 70's, my brother, a serious diabetic, needed a kidney transplant. No one in the family was a match, so we waited for a cadaver kidney. After about a month in the hospital, with a couple of close calls with rejection, and some months of recovery, he was able to return to a fairly normal life, but on a variety of anti-rejection drugs. About twelve years later, he needed another kidney. This time he was in and out within a week, and back to work within a month with almost no drug regimen. Now I read this story and I have visions of out-patient clinics. Amazing!
All this is possible because there are dedicated researchers and doctors working very hard to make life better. It is also thanks to people willing to be organ donors. Their efforts and their generosity gave my brother some thirty or more years of life that would not have been possible. Thanks to you he got to meet his grandchildren.
By the way, when I got the news that I was not a match for my brother, I immediately got out my driver's license and signed up as an organ donor. I highly recommend that everyone do the same.
All this is possible because there are dedicated researchers and doctors working very hard to make life better. It is also thanks to people willing to be organ donors. Their efforts and their generosity gave my brother some thirty or more years of life that would not have been possible. Thanks to you he got to meet his grandchildren.
By the way, when I got the news that I was not a match for my brother, I immediately got out my driver's license and signed up as an organ donor. I highly recommend that everyone do the same.
3
My heart sings at the prospect of so many dialysis patients being able to get a transplant! Bravo to those who do this honorable work.
I was on hemodialysis (HD) for 4 years. HD gets a bad rap, but it worked for me. Attitude made all the difference: I observed the dietary requirements, swam laps 3 times a week, did yoga, got lots of rest, and found a schedule allowing good quality 'life activity' time. When people pitied me, I told them that after 3 months without dialysis, I would no longer be alive! Wouldn't YOU accept to remain with the living in exchange for only 3 sessions of 5 hours? a no brainer... In addition, the staff at my Center was friendly and competent. I still visit them on a regular basis.
Did I want a transplant? Hell, yes! I found out that a kidney from a living donor lasted (statistically) twice as long as a kidney from a deceased donor. My mind was made up...
Then, one day using my iPad at dialysis, I discovered a website which changed my life: Living Donor Kidney Network (LDKN). It read: "You don't find the donor, the donor finds you." I had a strong inkling that someone in Louisville, Ky. (on the Compassionate City register) wanted to donate a kidney to me. In talking to a complete stranger about my situation (not REQUESTING), she looked at me and said some magic words, "Oh! I will give you a kidney." She was a match and since April 14, 2014, I have been a proud, healthy kidney recipient. No words can thank her for this gift!
I was on hemodialysis (HD) for 4 years. HD gets a bad rap, but it worked for me. Attitude made all the difference: I observed the dietary requirements, swam laps 3 times a week, did yoga, got lots of rest, and found a schedule allowing good quality 'life activity' time. When people pitied me, I told them that after 3 months without dialysis, I would no longer be alive! Wouldn't YOU accept to remain with the living in exchange for only 3 sessions of 5 hours? a no brainer... In addition, the staff at my Center was friendly and competent. I still visit them on a regular basis.
Did I want a transplant? Hell, yes! I found out that a kidney from a living donor lasted (statistically) twice as long as a kidney from a deceased donor. My mind was made up...
Then, one day using my iPad at dialysis, I discovered a website which changed my life: Living Donor Kidney Network (LDKN). It read: "You don't find the donor, the donor finds you." I had a strong inkling that someone in Louisville, Ky. (on the Compassionate City register) wanted to donate a kidney to me. In talking to a complete stranger about my situation (not REQUESTING), she looked at me and said some magic words, "Oh! I will give you a kidney." She was a match and since April 14, 2014, I have been a proud, healthy kidney recipient. No words can thank her for this gift!
17
I wonder if this will work for those of us with autoimmune diseases, like rheumatoid arthritis? These diseases, while not as dire as kidney failure, afflict so many people. This advance could change the lives of so many who are now suffering from incurable and degenerative diseases.
2
I made a non directed kidney donation in 2013 at St. Barnabas Medical Center (Livingston, NJ) that started a chain cascade in which several people received kidneys. Often people have someone willing to donate but that person is not a match. If their donor is willing to give to another recipient, the good ripples out infinitely. It takes is one person to step forward and give without expectation of receiving. The recovery time is minimal (overnight hospitalization and a few weeks to get your mojo back.) I donated on a Tuesday and was grocery shopping on Saturday with assistance. The recipient's insurance pays all medical costs for the donor. I haven't noticed any difference in having one kidney versus two and I have a very physical job now as a lavender farmer. Please consider sharing your spare!
23
As a person who is on the transplant list, THANK YOU for your generosity of spirit and body. May you receive many blessings People who do what you did are extremely rare. You saves lives!
2
Thanks for sharing your story, and THANK YOU for your selfless act. I've been considering doing the same. (College pal donated her kidney to her brother, I'd like to "pay it forward.")
2
What a wonderful advance for mankind. This is a true blessing for all of those who suffer from kidney failure. I wish it had happened years ago. It could have saved a dear friend's life.
5
The risks of live donation are underplayed and the benefits sometimes exaggerated: https://www.beaconreader.com/dan-walter/why-the-campaign-for-living-kidn...
5
I marvel at people's generosity. If you notice, these articles never discuss complications among either donors or recipients. Most times, overall things go well. But as someone who has experienced a surgical complication, I'm terrified of ever being under anesthesia again for any purpose, even to save my life, that is, what's left of it.
2
True. The transplant industry does not publicize the complication rate - or the potential long term consequences for donors.
They also work hard to foster the myth that it is some sort of freak of nature that people are born with two kidneys and that there is no downside to giving one away.
It is a big, entrenched business that plays on people's emotions and altruism in order to sustain itself, rather than focusing on preventing the causes of kidney disease and developing alternatives to live donation. http://bit.ly/1KwB3lu
They also work hard to foster the myth that it is some sort of freak of nature that people are born with two kidneys and that there is no downside to giving one away.
It is a big, entrenched business that plays on people's emotions and altruism in order to sustain itself, rather than focusing on preventing the causes of kidney disease and developing alternatives to live donation. http://bit.ly/1KwB3lu
4
We have a friend this might help. The one thing I wonder about is what does the donation of a kidney do to the life expectancy of the donor. After all, we evolved with two kidneys for as reason. Hopefully the reason is something ancient that no longer plays a role.
Hi Joe: I far as I know, donating 1 kidney does not affect the life of the donor as long as he/she keeps normal function in the 1 left kidney. From a physiological point of view we only need 1/4 of 1 kidney to maintain our blood chemistry normal. Those who are in dialyses have less than that of their kidney function left.
What a great thing
Amazing article and such an inspiring story. Working in healthcare, I am aware of the toll dialysis takes on an individual. It's mind blowing to know medicine is advancing to these levels. Gives our future a greater level of hope and security.
7
Would this desensitization process work for patients with severe allergies?
But renal disease is so common and can be prevented. Low sodium diet, diligent control of BP, lipids like cholesterol, weight and blood sugars and attention to genetic diseases like polycystic kidneys should keep it at bay. Doctors are frequently not vigilant about kidney disease--paying more attention to the heart at the expense of the kidneys. Kidney diseases are also complex, the areas of electrolyte imbalances and water balance being some of the most challenging topics to master in Medicine. Even recurrent kidney infections could land a patient on the dialysis table, so can ureteral obstructions from scars and stones, so can acute and severe dehydration and sepsis from infections as can numerous drugs that can destroy the kidney's nephrons--example--antibiotics that can lead to deadly eosinophilic or interstitial nephritis due to allergic reactions, as also proton pump inhibitors like Prilosec--as recently reveale and also psych meds and autoimmune disorders like lupus that can steadily corrode the kidneys. The diagnostic work up kidney failure is vast and complex and it can leave the most intellectually oriented, experienced and well read, in the field of Medicine, exhausted. As to why we're not into prevention in this country, but into awful and dire treatments is inexplicable to me. But I guess prevention is not sexy. A low protein, plant based diet should prolong kidney function because age itself is a cause of kidneys declining.
2
You make a valid point-- western medicine is long on treatment after the fact and short on prevention (the East / West, dare one say yin / yang phenomenon.) That said, not every kidney disease is preventable.
3
And some cannot be prevented. Polycystic kidney disease is genetic. Period. There is nothing that can be done to "prevent" this disease. Do some research before you comment.
3
@misty No one has to research before commenting. This is not a forum dedicated to medical professionals, it is a forum for laypeople to discuss the issue and provide anecdotal experience that others can either accept, ignore or use as a spur to perform additional research. Sorry if there is information that doesn't jibe with your "kidney donations yay!" position. There is another side to kidney donations, so to speak, that is rarely discussed and I have to wonder why.
4
This article is incomplete--it does not mention failure rates or complications. After all the antibodies are drained, new antibodies are given under the assumption patient's bone marrow will regenerate new antibodies and when these new antibodies are inimical they are treated to submission. At any time during this procedure a patient can fall prey to a lethal infection because he or she will be immunocompromised. There is much more to this procedure than meets the eye here. Yet, it is a triumph and I am proud because JHH, in the much maligned Baltimore, is the progenitor. Yes, it is in my backdoor and it is a brilliant institution. I don't agree with its politics or how it treats its employees, its town gown relationship or its ruthless expansions into East Baltimore but I bow to its academic excellence. It boldly goes, in Medicine, where angels fear to tread. The kidney exchange program started with JHH, too. Academic institutions under the ACA and under the current myopic insurance climate, are under assault and institutions like JHH have to struggle to find donors to support their scientists. Our country is in a morass of religious, superstitious and political mumbo jumbo. Ignoramuses rule, ignorance is strident, science languishes, the tightfisted and the ham handed tell the smart ones to go suck on lollipops while they dine on caviar. In Medicine the corporate carpetbaggers are in and the researchers are in the carpets they've bagged. Don't accept it.
5
Could this be extended to allow transplants from other species? Chimpanzees share about 99% of our DNA. It would obviously raise enormous ethical issues.
For anyone interested, this new study appears to be an expansion of a previous study, published in 2011, which you can access for free. http://www.ncbi.nlm.nih.gov/pubmed/21793744
In the 2011 study, the method was tested and found to lead to *double* the survival rate after 8 years when compared to (1) people on dialysis or (2) dialysis until a compatible donor kidney was transplanted. Patients were case-matched across all three treatment arms, that is, matched for demographics and medical characteristics.
As heartening as the results were from the 2011 study, researchers needed further evidence that this would work well at different medical centers and with a wider patient pool. That was the purpose of the recent study, which was done at 20 medical centers-- and the great outcomes were affirmed.
The reason a live donor is needed is that the transplant must be done within "a few days" of the treatment, or it loses its efficacy.
It sounds like it's time to start agitating for better insurance coverage for this-- and for costs by the donor, including lost wages, medical costs, and personal costs associated with donation.
Not sure what Phil from Denver was referring to when he said "they don't do as well as the standard patient"-- not supported by data, above.
Good luck, everyone!
And thank you to those of you who have donated. I am not personally or familially affected by this issue-- but everyone will have medical difficulties of some kind or another.
In the 2011 study, the method was tested and found to lead to *double* the survival rate after 8 years when compared to (1) people on dialysis or (2) dialysis until a compatible donor kidney was transplanted. Patients were case-matched across all three treatment arms, that is, matched for demographics and medical characteristics.
As heartening as the results were from the 2011 study, researchers needed further evidence that this would work well at different medical centers and with a wider patient pool. That was the purpose of the recent study, which was done at 20 medical centers-- and the great outcomes were affirmed.
The reason a live donor is needed is that the transplant must be done within "a few days" of the treatment, or it loses its efficacy.
It sounds like it's time to start agitating for better insurance coverage for this-- and for costs by the donor, including lost wages, medical costs, and personal costs associated with donation.
Not sure what Phil from Denver was referring to when he said "they don't do as well as the standard patient"-- not supported by data, above.
Good luck, everyone!
And thank you to those of you who have donated. I am not personally or familially affected by this issue-- but everyone will have medical difficulties of some kind or another.
4
be sure you sign up for th organ donor program in your state
its usually done through driver licenses
no matter how wretched and debauched you may think you are, some of your organs can make life better for someone else after your death
and what better gift could that be
its usually done through driver licenses
no matter how wretched and debauched you may think you are, some of your organs can make life better for someone else after your death
and what better gift could that be
3
Took the words right out of my mouth. My older brother had a liver transplant about 30 years ago, and that gave him six years of life he wouldn't have had. He got to see his sons graduate from high school and set off for college. My younger brother underwent two kidney transplants and the thirty years of life he got allowed him to see his daughters grow up and he got to cuddle with his granddaughters. They both received this because someone signed the back of their driver's license.
3
Piles of data continue to confirm that the greater danger goes to the donor, not the recipient, regardless of the match quality, this fact remains a hidden secret to the family members mulling this decision---------it would be curious to determine the lengthy and depth of this study versus this new drug.
1
Document 'Piles of data', please.
2
the pub med data base, for one, and the experience of transplantation since its origin back in the early 1970s at the U of Pitts
This is wonderful news for so many patients. Congratulations to the diligent researchers and medical teams who found an alternative.
A delightful neighbor waiting for a kidney died nearly 3 years ago. Years and years of dialysis while waiting for a match had several complications. His odds of a match were poor as he was originally from Turkey 40 years earlier. Despite being a successful businessman his money could not save his life.
A delightful neighbor waiting for a kidney died nearly 3 years ago. Years and years of dialysis while waiting for a match had several complications. His odds of a match were poor as he was originally from Turkey 40 years earlier. Despite being a successful businessman his money could not save his life.
6
How incredible that these advances will help save more people's lives!
7
Yup! How much better if we could prevent this. Many an American goes to dialysis from overuse of NSAIDs like Ibuprofen and Naproxen. These non steroidal anti inflammatories, available freely OTC, are lethal to the kidneys if a steady dose is fed to a person. It is a crime that meds so damaging to an organ as precious as the kidney, like Motrin or Prilosec or Nexium, are marketed vigorously and are available OTC. It is, I would say, unconscionable even, that the choice is left to patients to use or not to use these drugs and how much to use or how often. As a doc I am astounded how many patients do not actually know how many medications are nephrotoxic and fall into habitual use for alleviation of pain etc, eventually seeing themselves before a dialysis machine. No excuse. No excuse whatsoever for this state of affairs. Of all the organs in the body, the kidneys are most vulnerable but also highly salvageable through meticulous prevention, close lab monitoring and prompt and early responses to decline.
3
Many physicians don't understand the damage NSAIDs cause, as in (re: ibuprophen), "take as many as it takes to relieve your pain"!
The first thing that jumps into my head is, would this be an effective treatment for autoimmune diseases such as multiple sclerosis, lupus, and etc. I am sure the people who developed the desensitization technique have already thought about this; and if I was a science reporter, it would have been among the very first questions I would have asked.
58
My thoughts in a similar vein were to wonder if this would work for asthma or other allergies.
I have a family member who was diagnosed with Lupus and thought of the same exact question.
The procedure they are talking about is called plasmapheresis. This procedure has been used for decades now for many different conditions, some autoimmune diseases included. I am a physician who performs plasmapheresis, and we have already used this for desensitization for heart transplants. I think it's great that its use can be expanded to kidney transplant, but there also needs to be more awareness in the medical community about all of the other indications and potential benefits of plasmapheresis.
How wonderful.
Both of my parents, inexplicably, were dialysis patients.
My mom starting in her early 80's, my dad, late 80's.
They had to go to what I will call: a dialysis franchise; three times per week, 7 hours per visit. A kind of McDonald's but with La-Z-Boy chairs, extraordinarily expensive: surely Medicare and tax payers were duly bilked. It went on for years.
To this day, I am tormented that this was how their lives ended. It had to have been tortuous for both of them: lively, kind Americans who deserved a better ending.
Both of my parents, inexplicably, were dialysis patients.
My mom starting in her early 80's, my dad, late 80's.
They had to go to what I will call: a dialysis franchise; three times per week, 7 hours per visit. A kind of McDonald's but with La-Z-Boy chairs, extraordinarily expensive: surely Medicare and tax payers were duly bilked. It went on for years.
To this day, I am tormented that this was how their lives ended. It had to have been tortuous for both of them: lively, kind Americans who deserved a better ending.
41
Thank goodness there are bona-fide scientists in this world, making new discoveries from their rigorous and disciplined work over many years, and carrying our planet forward toward a brighter future for all.
24
I was a zero-match transplant donor; my recipient's doing fine, it's been 15 years. He's on immunosuppressants--we are the same blood type, but no shared antigens.
Took about 6 weeks to recover and about 10 years to stop casually dropping it into conversations. It was a lot of fun and I highly recommend it, though it was like getting hit by a truck (I had the open procedure, not the laproscopic). Gave birth to my third child after donating, ran the NYC Marathon last year.
Someday they'll be growing kidneys in petrie dishes and you won't have the chance to engage in some heroics for the people you love--better get it while it's hot.
Took about 6 weeks to recover and about 10 years to stop casually dropping it into conversations. It was a lot of fun and I highly recommend it, though it was like getting hit by a truck (I had the open procedure, not the laproscopic). Gave birth to my third child after donating, ran the NYC Marathon last year.
Someday they'll be growing kidneys in petrie dishes and you won't have the chance to engage in some heroics for the people you love--better get it while it's hot.
54
That was my experience too -- zero match to a coworker who had no problem with it. This is great step forward. I wish more people knew about living donation -- that you only need as much compatibility as for blood donation, and that any healthy adult can probably do it. For me, it was actually a lower bar than blood donation, where I was turned away for being too small.
I sometimes imagine walking up to abortion clinic protesters and handing out pamphlets about our excellent local transplant center..."Look, you could save a life with YOUR body, if you're willing to do yourself what you ask of these women: to put their lives and health on the line for a stranger. Right now, someone is dying for lack of a kidney you're carrying. Are you pro-life for real? Prove it -- get tested. You can't imagine how thrilling it is to meet the person you saved..."
Oh, how I wish I had the nerve...maybe it would start a movement...
I sometimes imagine walking up to abortion clinic protesters and handing out pamphlets about our excellent local transplant center..."Look, you could save a life with YOUR body, if you're willing to do yourself what you ask of these women: to put their lives and health on the line for a stranger. Right now, someone is dying for lack of a kidney you're carrying. Are you pro-life for real? Prove it -- get tested. You can't imagine how thrilling it is to meet the person you saved..."
Oh, how I wish I had the nerve...maybe it would start a movement...
42
Great comment!!!!!
2
To some commenters: the article specifically mentions that this works for LIVING donors only. Thus, it is not yet applicable to other organs. Maybe someday.
6
Depending on the recipient's size, transplanting the right hepatic lobe, or a lobe of lung, from a living donor is possible and currently performed.
Although the science is there, there are 2 issues that prevent this from being more common, both regulatory:
1. the added expense of $30,000 is not paid by insurance, usually. It's not paid ever by Medicare which is the most common payer. Large centers may be able to afford the loss, but even non-profit smaller center can't afford to lose money on too many transplants. Right now the margin for kidneys is so tight that we lose money on many each year. This could be easily fixed by paying a higher case rate for desensitization protocols. It's still cheaper than dialysis.
2. Transplant programs are judged by outcomes, and may be shut down if outcomes are significantly worse than expected. UNOS (United Network of Organ Sharing) calculates expected survival for all transplant recipients based on a number of factors, however, desensitization is not one of them Although these patients do well, they don't do quite as well as the standard patient, and not accounting for this in the survival model places programs in jeopardy of being flagged for poor outcome. Again, easy fix.
I know Drs. Segev and Montgomery have worked hard to change this, and I hope they will be successful.
1. the added expense of $30,000 is not paid by insurance, usually. It's not paid ever by Medicare which is the most common payer. Large centers may be able to afford the loss, but even non-profit smaller center can't afford to lose money on too many transplants. Right now the margin for kidneys is so tight that we lose money on many each year. This could be easily fixed by paying a higher case rate for desensitization protocols. It's still cheaper than dialysis.
2. Transplant programs are judged by outcomes, and may be shut down if outcomes are significantly worse than expected. UNOS (United Network of Organ Sharing) calculates expected survival for all transplant recipients based on a number of factors, however, desensitization is not one of them Although these patients do well, they don't do quite as well as the standard patient, and not accounting for this in the survival model places programs in jeopardy of being flagged for poor outcome. Again, easy fix.
I know Drs. Segev and Montgomery have worked hard to change this, and I hope they will be successful.
22
"....so patients must have a living donor." Why? Can't cadaver kidneys be used after desensitization? The antibodies removed sound like they are not specific to just one person's kidney.
Also, what about the other arm of the immune system, the delayed type, cell mediated immunity which does not involve antibodies? Doesn't that still play a role in organ rejection?
Also, what about the other arm of the immune system, the delayed type, cell mediated immunity which does not involve antibodies? Doesn't that still play a role in organ rejection?
2
It's possible that the desensitivation is not permanent, so it needs to be done during the two weeks prior to the transplant. A cadaver kidney wouldn't last that long and it wouldn't be possible to predict when one would become available.
3
Cadaveric transplants are ruled out because there is no established donor in advance of the procedure. Kidneys survive /maybe/ thirty hours on ice, so a two-week protocol between harvest and transplant is simply not possible.
3
I would be willing to bet that there are researchers working on these issues even as I'm writing this. You have to remember that just about fifty years ago, a transplant between identical twins was front page news; Life (or was it Look?) magazine devoted an entire issue to the story. Now, there is an entire wing at the University of Wisconsin hospital devoted to transplants of all kinds. We've come a long way!
What an astounding article! I'm wondering if some of the same techniques could be used on patients with autoimmune diseases, such as FSGS. This could hopefully head off dialysis and transplants entirely. Bravo to the pioneers, both doctors and patients!
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As a healthy diabetic of forty years, I'm encouraged by this development. Haunting every diabetic is the possibility of complications. I'm wondering if the procedure has the potential for pancreas transplants.
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Does this procedure allow the recipient to avoid taking anti-rejection medicines? These medicines are toxic to the kidney and reduce its life span in the recipient.
14
That's my question too. I had a transplant five years ago and every day I wonder about the immunosuppression drugs I take because I know they are toxic to my transplanted kidney.
No. The usual medications still apply. To clarify, this process is one which allows particularly sensitized patients--who would have a high likelihood of rejecting an organ--to still participate in transplant. The news here is not the process, which has been used for years. It is the finding that over years, highly sensitized patients who try this do better than highly sensitized patients who do not.
5
I am a kidney donor and applaud any protocols that can expand this life-giving procedure.
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This this is very penetrating writing by Gina Kolata, and great news. I have friends, donator and recipient, who are related, who underwent the operation in 1995 both are alive and well today. If we can extend this procedure, it benefits so many people. Mr. Smith looks to be in great shape, optimum weight, and is a good recipient.
$130,000 is cheap for this operation. This nation dropped trillions of dollars into the Iraq war to no avail. For the sake of argument, suppose we dropped 2 trullion dollars. At $130,000 an operation, that would cover 15 million recipients.
$130,000 is cheap for this operation. This nation dropped trillions of dollars into the Iraq war to no avail. For the sake of argument, suppose we dropped 2 trullion dollars. At $130,000 an operation, that would cover 15 million recipients.
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This is good news.
I also wonder how many people on hemodialysis are offered the opportunity to try peritoneal dialysis. Hemodialysis involves gonig to the center three or four times a week and staying there for hours. Peritoneal dialysis is home-based and involves having fluid in the abdominal cavity which allows the toxins to filter through the peritoneum in to the fluid and changing the fluid regularly. My dad was on peritoneal dialysis after his kidneys failed and the constant cleansing kept him feeling well; in addition his kidneys did not stop producing urine and the respite peritoneal dialysis offered allowed them eventually to regain some function. He had a much better quality of life with the PD than he had with HD.
I also wonder how many people on hemodialysis are offered the opportunity to try peritoneal dialysis. Hemodialysis involves gonig to the center three or four times a week and staying there for hours. Peritoneal dialysis is home-based and involves having fluid in the abdominal cavity which allows the toxins to filter through the peritoneum in to the fluid and changing the fluid regularly. My dad was on peritoneal dialysis after his kidneys failed and the constant cleansing kept him feeling well; in addition his kidneys did not stop producing urine and the respite peritoneal dialysis offered allowed them eventually to regain some function. He had a much better quality of life with the PD than he had with HD.
19
I think it depends on the doctor. My doctor said PD would be best for me as a kind of stepping stone towards transplant. If it looked like I wasn't going to get a transplant, he said he would want me on Home Hemo - where you would do it at home.
Thankfully I was able to receive a preemptive transplant. But if it should fail one day I'm sure I would be put on PD.
Thankfully I was able to receive a preemptive transplant. But if it should fail one day I'm sure I would be put on PD.
7
To Tessa: Although peritoneal dialysis is an option,it is best practice when it is used in adults who are meticulously compliant with their treatment and have the eyesight,dexterity and mobility to use PD instead of hemodialysis.
Your father was fortunate. Many individuals are not in the situation where the strict regimen of PD for kidney failure is possible. Hemodialysis is simpler in some ways because much of the "work" is offloaded from the patient to the dialysis clinic. Still, for the HD patient transport,diet control and weight monitoring are the patients responsibility (or their caregivers). I've seen far too many patients who miss their HD appointments due to transportation issues. Add on the patients responsibilities for diabetes control,hypertension control, and drugs for auto-immune renal failure...it all becomes rather problematic over the course of a few years.
Peritoneal dialysis is not an option for a large segment of patients in renal failure. Your dad was very fortunate to have the ability to manage his own PD. PD also has some very worrisome complications- catheter infection leading to peritoneal infection.
See: http://www.niddk.nih.gov/health-information/health-topics/kidney-disease...
or
http://www.pdiconnect.com/content/29/Supplement_2/S59.full
for more info comparing PD and HD.
Your father was fortunate. Many individuals are not in the situation where the strict regimen of PD for kidney failure is possible. Hemodialysis is simpler in some ways because much of the "work" is offloaded from the patient to the dialysis clinic. Still, for the HD patient transport,diet control and weight monitoring are the patients responsibility (or their caregivers). I've seen far too many patients who miss their HD appointments due to transportation issues. Add on the patients responsibilities for diabetes control,hypertension control, and drugs for auto-immune renal failure...it all becomes rather problematic over the course of a few years.
Peritoneal dialysis is not an option for a large segment of patients in renal failure. Your dad was very fortunate to have the ability to manage his own PD. PD also has some very worrisome complications- catheter infection leading to peritoneal infection.
See: http://www.niddk.nih.gov/health-information/health-topics/kidney-disease...
or
http://www.pdiconnect.com/content/29/Supplement_2/S59.full
for more info comparing PD and HD.
9
I had a living donor for my first transplant this was in 2002 where this was just a concept at the time. But my body rejected the kidney I wonder if this was available if the kidney would have survived. I think back then they were talking about getting bone marrow as well as a study. My kidney transplant when necrotic. ended up with enough surgery scars to look like a state road map. I also took 9 units of blood which put me in the "will reject 99% of cadaver kidneys" I was unable to do peritoneal dialysis due to too much scar tissue due to multiple surgeries due to a failed transplant. There are some drawbacks with peritoneal as well such as diving and the potential of infection at the site. I ended up doing hemodialysis for several years till I won the Unos lottery jackpot, cadaver kidney now 11 years strong, I was 4th on the call list for that kidney to this day I have no idea why the 3 in front of me said no to the transplant, but I am very thankful whoever they were.
This is wonderful news and a promising development. Of the more than 100,000 waiting for kidney transplants in the US, fewer than 17,000 people receive one each year. Desensitization could drastically increase that number, improve the quality of life for those who would no longer need dialysis, and reduce the huge strain that the cost of dialysis places on the Medicare system. This is a hugely significant development, as kidney disease is the 9th leading cause of death in the United States, killing more people than breast or prostate cancer each year. Additionally, 1 in 3 Americans are at risk for kidney disease and 26 million American adults have kidney disease -- and most don't even know it. I have chronic kidney disease and I was fortunate enough to have a live donor, my wife, and I had a successful kidney transplant three years ago. This article is quite timely as March is National Kidney Month and March 10 is World Kidney Day. This development is certainly worth celebrating.
40
That number has jumped to 31 million Americans.
2
Lets hope Canada jumps on this new discovery. If we organize fast enough we could junk our dialysis machines in two years. Lets go, Mr. Trudeau!
9
The Watkins and Smith families' story is beautiful. May we all have such good and caring friends.
36
This isn't new. It just isn't available everywhere. This is called an ABOi transplant. Desensitization is done through plasmapheresis. Not every recipient can qualify to participate in this. My antibodies were too high and I would have required too many treatments of plasmapheresis.
if you have a donor willing to donate a kidney, that person will be willing to donate to anyone to keep you alive. I would recommend participating in a kidney exchange instead. This way you can save more than one life.
if you have a donor willing to donate a kidney, that person will be willing to donate to anyone to keep you alive. I would recommend participating in a kidney exchange instead. This way you can save more than one life.
17
What's novel here is that the research shows that incompatible transplants perform better than dialysis or deceased donor kidneys. Pretty encouraging!
10
Denisse, I do not know all of the specific details about this new approach, but I am a retired medical researcher who headed a lab that did research on immunology and vaccination for many years. It does not sound like an ABOi procedure to me. That involves getting rid of antibodies that recognize the A and B blood groups on the surface of red blood cells. The new approach sounds to me like they are getting rid of all the antibodies in the blood, possibly by filtering the blood plasma through an "affinity column" that pulls out all antibodies prior to the transplant. The patient can later generate new antibodies from cells that originate in the bone marrow. What is amazing and seems to be crucial is that the newly generated antibodies are unable to recognize the transplant as a "foreign body" and thus do not attack it. A crucial feature of the immune system is its ability to recognize and distinguish "self" from "non-self". Foreign "non-self" materials can then be attacked by antibodies and immune cells, while "self" materials are recognized and ignored by the immune system through a process called "immune tolerance". I'm just guessing how this new approach works but I don't think I'm far off.
17
Yes, live kidneys are the best choice, if one is available.
I have a picture of the one I donated -- it surprised me, very small, pink and cute in a basin of ice water. (When I handed my very chill surgeon the disposable camera in pre-op, he just said, "No one has ever asked me that before...")
I have a picture of the one I donated -- it surprised me, very small, pink and cute in a basin of ice water. (When I handed my very chill surgeon the disposable camera in pre-op, he just said, "No one has ever asked me that before...")
6
Very interesting article. I am surprised it took Judge Watkins so long to recover. My friend gave a kidney two years ago and he was fine in a few weeks. (He was around 50 when he donated.)
Judge Watkins and others who donate are heroic people. Another friend of mine is now experiencing kidney failure, and we are all hoping that a friend or relative will choose to make this gift that will change the donee's life forever.
Judge Watkins and others who donate are heroic people. Another friend of mine is now experiencing kidney failure, and we are all hoping that a friend or relative will choose to make this gift that will change the donee's life forever.
23
I donated in October. It was way more than a few weeks until I was "fine," and I'm 39. I'm glad I did it, and would do it again in a heartbeat, but recovery from losing an organ is no joke. Your comments make it seem like giving blood. It isn't.
22
It's a fantastic new medical advance, but I worry about two potential negative long-term repercussions. Primarily, when someone's immune system has been sufficiently suppressed to avoid transplant rejection, it seems likely that they'd be more receptive to infection of various kind. So they might be much more likely to contract pneumonia and so on, and it could wind up with them contracting some infectious disease, or a staph infection, and being in just as much risk of dying.
The longer term worry is about the death penalty and our justice system. If we keep making it easier to transplant organs, and such things are always life-extending, then when are we going to get around to legislating that all condemned prisoners be total organ donors? They'd be a good stock of healthy organs, and if we go that route, the death penalty is going to be applied to smaller crimes, as the voters will want a steady supply of replacement organs so they can live past the century mark.
Might sound crazy but it would go along with standard human motivations and brushing aside morality in favor of expedience. Nonetheless, on the face of it, this is probably a good thing overall.
The longer term worry is about the death penalty and our justice system. If we keep making it easier to transplant organs, and such things are always life-extending, then when are we going to get around to legislating that all condemned prisoners be total organ donors? They'd be a good stock of healthy organs, and if we go that route, the death penalty is going to be applied to smaller crimes, as the voters will want a steady supply of replacement organs so they can live past the century mark.
Might sound crazy but it would go along with standard human motivations and brushing aside morality in favor of expedience. Nonetheless, on the face of it, this is probably a good thing overall.
3
Good thing we prevented the Wright Brothers from learning to fly, otherwise within a few decades people would be using airplanes to bomb each other...
Yes, yes it sounds crazy. No one is talking about harvesting organs from criminals (ok so it has been said to have happened in far off places), but to deny scientific advances because someone might take a crazy leap would in itself be crazy.
As a matter of logic, increasing the viability of kidneys to a greater number of patients would in fact lessen the pressure to harvest organs from unwilling donors, as the need to match specific blood type/etc. would be removed making it possible to utilize a far greater number of organs that become available or are offered by good samaritans than are currently able to be used due to these limitations.
Taking this potential break through into crazy town does no one any benefit.
Yes, yes it sounds crazy. No one is talking about harvesting organs from criminals (ok so it has been said to have happened in far off places), but to deny scientific advances because someone might take a crazy leap would in itself be crazy.
As a matter of logic, increasing the viability of kidneys to a greater number of patients would in fact lessen the pressure to harvest organs from unwilling donors, as the need to match specific blood type/etc. would be removed making it possible to utilize a far greater number of organs that become available or are offered by good samaritans than are currently able to be used due to these limitations.
Taking this potential break through into crazy town does no one any benefit.
13
I agree. I think if someone is willing to donate a kidney to you then they can just sign up for a kidney exchange program and donate to someone else. That way, the recipient might be able to find a better match in the chain and more lives can be saved.
1
I think it's a good option to have if there is no other option left.
1
I don't see why -- despite what the article says -- dead donors couldn't be used.
If it takes weeks to prep the recipient, then there will probably be a several-day period during which the new kidney could go in. Surely, in a several-day period, there will be suitable donors who will die.
I don't mean to sound ghoulish, but lots of people who've signed up to be organ donors die every day. Surely supplying the viable kidney wouldn't be a problem.
If it takes weeks to prep the recipient, then there will probably be a several-day period during which the new kidney could go in. Surely, in a several-day period, there will be suitable donors who will die.
I don't mean to sound ghoulish, but lots of people who've signed up to be organ donors die every day. Surely supplying the viable kidney wouldn't be a problem.
18
There is a waiting list for cadaverous donors, and you never know when you're number is called, because there is fluctuation in supply. So, you could never be sure you were prepping in the right window of opportunity for a cadaveric kidney, which is why living donor kidneys are used; for those operations, surgeons can time the desensitization and transplant procedures exactly.
19
Deceased donors ARE used - all the time - but in fact very few kidneys are suitable for transplantation. Typically, a donor must have suffered brain death, through a car accident, let's say, but still have other functioning organs. People who've died of cancer, for example, are not potential donors. Fortunately (or unfortunately) relatively few die this way.
11
The HLA desensitization protocol is donor-specific. While plasmapheresis indiscriminately removes antibodies from the recipient's blood, ultimately it's the cross antibodies that need to be cleared to avoid rejection, and these wouldn't be identified in advance of a deceased donation.
Perhaps more importantly, the majority of patients on transplant waiting lists are not HLA sensitized, and matched transplants have a significantly better outcome than incompatible transplants. So the most good would come out of a cadaver organ given to the best-matched (thus non-sensitized) recipient. I think the article doesn't emphasize enough that the new protocol really only affects patients with no other options. If a matched transplant is at all possible, including through an exchange, it would be preferable to attempting a higher risk, lower benefit HLA-incompatible transplant.
Perhaps more importantly, the majority of patients on transplant waiting lists are not HLA sensitized, and matched transplants have a significantly better outcome than incompatible transplants. So the most good would come out of a cadaver organ given to the best-matched (thus non-sensitized) recipient. I think the article doesn't emphasize enough that the new protocol really only affects patients with no other options. If a matched transplant is at all possible, including through an exchange, it would be preferable to attempting a higher risk, lower benefit HLA-incompatible transplant.
7
As a kidney recipient who has had my kidney for 30+ years (32 years on March 8, I laud any advancement that can help those not as lucky as I.
To have kept my kidney this long I had to have had a "perfect match" where my hero brother's immune system perfectly matched my own...a rare thing.
I fervently hope this new procedure brings about more stories like mine.
To have kept my kidney this long I had to have had a "perfect match" where my hero brother's immune system perfectly matched my own...a rare thing.
I fervently hope this new procedure brings about more stories like mine.
86
30 years! As a dialysis social worker, I am thrilled to hear such a hopeful story. Kudos to you for taking such good care of your brother's wonderful gift.
52
Regarding the care of my transplant, I got the straight story about what I had to do and loving support from people like you.
2
This is wonderful news! I am looking forward to learning more about this protocol.
16