Time of Antibody Response Key to Rejection in Kidney Transplant

The antibodies produced in transplant recipients before donor kidney transplant were found to be associated with better outcomes than if the antibodies were produced after the transplant, according to a study published in the Journal of the American Society of Nephrology (JASN). Antibody response produced against donor organs are the main reason for rejection and they can be produced

• Before the transplantation (donor specific antibodies)
• After the transplantation (de novo specific antibodies)

It is important to determine the role of antibodies in organ rejection to ensure that the donors are matched with the recipients before transplantation. A research team led by Dr. Alexandre Loupy and colleagues from the Paris Translational Research Center for Organ Transplantation (France) along with Dr. Phil Halloran from the Alberta Transplant Applied Genomics Centre (Canada) studied kidney transplantation rejection mediated by antibodies in 205 patients. Out of these patients

• 103 patients had antibodies that were present before transplantation that were donor-specific
• 102 patients developed antibodies after transplantation- de novo

The study found that regardless of the treatment provided, the superior kidney survival was vastly different

• 63% in patients with pre-existing antibodies
• 34% in patients with de novo antibodies

Dr. Aubert stated that the study highlighted that organ rejection due to pre-existing antibodies were associated with a significantly lower chance of rejection than people with de novo antibodies.

The results show that transplantation in patients who have antibodies in their system would have a more encouraging outcome. Contrary to the outcome of this study, patients who have pre-existing antibodies would normally not be considered to be good candidates for transplantation due to the presence of an increased amount of sensitization, which would limit their chances of finding a compatible kidney.

Living Kidney Transplantation Program in India

• There have been great strides in the living kidney transplantation program in India over the past 45 years, making it largest program in the world in terms of mere number of transplants done every year. The Indian parliament passed the law associated with transplantation in 1995 which has made transplantation from brain death’s also possible. Chronic kidney disease leads to approximately 735,000 deaths annually.
• Between 151 and 232 per million population require kidney transplantation in India due to end stage kidney disease.
• Only 7500 kidney transplantations are currently provided in about 250 kidney transplant centers in India.
• Out of them only 10% were from deceased donors while 90% were from living donors.

Immuno-suppressive Drugs:

Current strides in medical treatment have allowed the use of immune suppressive drugs as opposed to the use of steroids that were given earlier to prevent graft rejection. There have been many minimally invasive methods that have been devised to manage the complications associated with transplant surgery.

The current study that identifies the presence of antibodies to be a key factor in determining kidney rejection would aid in providing better care for kidney transplant patients. There is a need to closely monitor patients to ensure that there is no de novo increase in antibodies; suitable therapies can then be devised to ensure that the newly synthesized anti-bodies don’t lead to the rejection of the kidney.

The current understanding of the importance of antibodies in kidney transplantation rejection will aid in including patients who were earlier rejected due to the presence of pre-existing antibodies. In fact, these patients were found to be better candidates than people who developed the antibodies after transplantation.

Reference:

1. Current trends in kidney transplantation in India - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4970385/)

Source-Medindia