Immunology

Plasmapheresis is used, along with IV medications, to desensitize patients before transplant.

Making a match

Kidney desensitization program readies challenging patients for organ transplant

issue 16 | summer 2012

Kidneys are in high demand. Of the 3,000 people listed for organ transplant in Michigan, more than 2,400 are waiting for kidneys.

The odds of getting a transplant are even tougher when a patient is sensitized -- as about 30 percent of patients are -- often from a previous transplant, pregnancy or transfusions. Sensitized patients have high amounts of antibodies in their blood that not only make a match difficult, but also increase the odds that a kidney transplant will fail.

The University of Michigan Transplant Center is the only center in Michigan that offers kidney desensitization, a process that removes unwanted antibodies from the bloodstream using IV medications and plasmapheresis. Desensitization can be performed in patients with potential living donors against whom they have antibodies or are blood type incompatible, or patients who are waiting for a deceased donor transplant.

"Sensitization is more common in part because we are doing so many more retransplants," says Randall Sung, M.D. associate professor of surgery at the U-M Medical School. Sung leads U-M's kidney transplant program, along with Millie Samaniego, M.D. professor of nephrology, who also leads the desensitization program.

U-M also has a single-center paired donation program that can identify other possible living donors. "So if we have a specific donor in mind, we can reduce antibodies against that donor or possibly against another donor in the paired donor pool. For patients on the wait-list, desensitization doesn't have to be 100 percent complete, since there are many possible donors," says Sung.

Sung and Samaniego say that desensitization is often successful and could be applied to many more patients in need of a transplant. "We have state-of-the-art facilities that can characterize antibodies and antibody levels, along with a willingness to treat patients who are at higher risk," says Sung.

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