Desensitization Helps Fight Rejection in Transplants, Doctors Say

MILWAUKEE _ Surgeons at the University of Wisconsin-Madison say they have performed the country’s first successful operation that replaces a person’s kidney and pancreas with the organs of a deceased donor.

A head surgeon said that had it not been for a treatment called desensitization _ a dialysis-like procedure that removes the antibodies that can cause organ rejection _ Cheryl Kinas might have been waiting indefinitely for the organs she so desperately needed.

“If you have antibodies against 80 percent of the donors, it’s you against the world,” said physician Milagros Samaniego, University of Wisconsin Hospitals and Clinics desensitization program director.

According to the United Network for Organ Sharing, which maintains the national transplant waiting list, 72,355 people in the United States are waiting to receive a kidney.

Many people waiting for transplants _ medical experts say about 30 percent _ are considered “sensitized.” Through previous transplants, blood transfusions or pregnancy, they have developed a high concentration of antibodies, the proteins that bind to and destroy foreign agents such as viruses and are part of the body’s normal immune response.

But the same mechanism that protects a body from infection can become deadly for a transplant patient. Antibodies that recognize and attack foreign tissue will cause a transplanted organ to fail within one or two weeks of replacement, Samaniego said.

Physician Thomas Peters, a medical advisory board member for the American Association of Kidney Patients, said that while it is not known how many patients have been desensitized and received transplants in the United States, he thinks that very few sensitized patients face the threat of dying on dialysis while waiting for transplants.

However, Peters added, people who have gotten transplants generally live longer than those facing a lifetime of dialysis.

“If we could transplant the majority of transplant patients, we think there would be lives saved,” Peters said.

Kinas, who had two transplant surgeries before the operation in May, said she had been on dialysis for two years before she learned of the hospital’s desensitization program.

“It didn’t take a lot of convincing,” said Kinas, 48. “I had to get those antibodies lowered.”

The Baltimore-based Johns Hopkins Hospital pioneered desensitization in 1998, but the procedure is not widely administered in the United States. Other major centers for desensitization transplants in the U.S. include the Mayo Clinic in Rochester, Minn., which has completed more than 150 of these surgeries, and Cedars Sinai in Los Angeles.

Since the University of Wisconsin Hospital kidney desensitization program began in 2004, surgeons have performed 22 specialized transplant surgeries. Kinas represents the 23rd, and the only patient who received both organs from a deceased donor.

Samaniego said that although she and surgical colleagues Jon Odorico and Hans Sollinger are enthusiastic about desensitization, one problem with the process is that it is unspecific and eliminates all of the body’s antibodies.

Desensitization also makes the body more susceptible to illness, and sometimes the damaging antibodies return. Most people who opt for desensitization receive organs from a live donor because it takes at least two weeks for the treatment to remove the antibodies from the blood.

Kinas understood that, through desensitization, she stood a better chance of getting a transplant. Still, she had no idea how long it might take for organs to become available.”

Prabir Roy-Chaudhury, a nephrologist at the University of Cincinnati School of Medicine, said that as an alternative to the blood-filtering treatment, sensitized patients can choose to participate in a “kidney swap” program, also known as a “paired kidney exchange.” In the exchange, a living donor who is unable to give an organ to a loved one because of mismatched blood type gives to a suitable second recipient instead. In return, the second recipient’s donor gives an organ to the first recipient.

“If you have a barrier, one way is to smash the barrier down, but another way is to go around the barrier, which is like through this kidney swap program,” Roy-Chaudhury said.

In addition, Peters added, desensitization can be costly and time-consuming.

But Kinas said it was a miracle that she received two organs. Since the completion of the eight-hour surgery, Kinas said, she has been spending time at home resting.

“I’m doing well. Every day is a little bit better,” Kinas said.

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