Kidneys from Incompatible Live Donors Offer a Survival Advantage
Survival rates are lower among patients who receive a deceased-donor kidney or remain on the transplant waiting list.
Recipients of a kidney from an HLA-incompatible live donor have substantially better survival than individuals who receive a kidney from a deceased donor or who remain on the transplant waiting list, according to study.
At 8 years, patients who received a kidney from an HLA-incompatible donor had a survival rate of 76.5%, which was significantly higher than the survival rates for 2 control groups: patients who remained on the transplant waiting list or received a kidney from a deceased donor (62.9%) or those who remained on the waiting list and did not receive a transplant from a deceased donor (43.9%). The survival benefit was observed across all donor-specific antibody levels, researchers reported in The New England Journal of Medicine (2016;374:940-950).
“For the first time, we have definitively shown that incompatible live donor kidney transplantation provides almost twice the survival of a patient's next best option,” lead investigator Dorry L. Segev, MD, PhD, an abdominal transplant surgeon at Johns Hopkins University School of Medicine, said in a university-issued press release. “This is great news for patients who have healthy, willing live donors but who have been relegated to the waiting list because of HLA incompatibilities. Through this study, we now know that those donors can donate today, those transplants can happen and those lives can be saved.”In the study, which involved 22 transplant centers, Dr. Segev and his colleagues compared survival rates among 1,025 recipients of kidneys from incompatible live donors, 5,125 patients on a transplant waiting list or received a deceased-donor kidney, and 5,125 patients on a waiting list and did not receive a deceased-donor kidney.
HLA incompatibilities are not accounted for in case-mix-adjusted benchmarks, so centers performing transplants with kidneys from incompatible donors may be subjected to regulatory scrutiny and loss of certification from the Centers for Medicare and Medicaid Services, the researchers stated.
“Given such pressures, many transplant centers have avoided transplanting kidneys from incompatible live donors,” the investigators wrote. “However, for most sensitized patients, receiving a compatible kidney is not an option: their choice is to undergo desensitization or remain on the waiting list, which is associated with a high mortality rate.”