The number of Americans and Chicagoans suffering from chronic kidney disease has drastically increased in recent years, driven by high rates of hypertension and diabetes. Likewise the reported cases of patients with end stage renal disease has risen, which can only be treated with dialysis or a kidney transplant. And despite improvements in dialysis technology and the possibility of transplant errors, the transplant remains the most effective and preferred treatment due to its better long term outcomes and quality of life.
According to the National Kidney Foundation, almost 80,000 Americans are currently on a waiting list for a new kidney. However, not everyone is considered a prime candidate for transplant surgery.
Consider the case of a stunned patient suffering from kidney failure who was informed by a group of physicians that her mother’s attempts to donate one of her own kidneys was out of the question. Like 3 out of 10 kidney-transplant candidates, this patient had tested positive on a panel reactive antibody (PRA) blood test, which revealed that the patient had high levels of PRAs, or proteins that attack foreign tissue. So even though her mother’s kidney would have been a good match based on its blood type and tissue, the patient’s body would have attacked it.
Until recently patients with high PRA levels had little chance of success for transplantation and were oftentimes forced to remain on dialysis. In fact, as recently as 10 years ago a kidney transplant was absolutely contradicted for patients with high PRA levels. Increased PRA levels can be caused by blood transfusions, pregnancy, or a previous transplant.
Fortunately, there are new measures that can be taken so that patients with high PRA levels can undergo medical transplants. As this particular patient discovered, transplant specialists are currently exploring a strategy to lower PRA levels in patients like herself by administering high doses of Intravenous Immunoglobulin (IVIG) before the transplant surgery.
IVIG is a drug derived from the pooled blood of hundreds of donors and has been used to treat various immune disorders for at least 30 years. This particular patient underwent IVIG desensitization and was able to receive her mother’s kidney during a successful transplantation, which continues to function effectively today. While not all hospitals are equipped to perform the desensitization and subsequent surgery, there are some in Chicago and nationwide that have experienced success with this new type of transplant.
However, despite the successes, some transplant surgeons are concerned about the future of these sorts of transplants because of new measures being implemented by Medicare. Following reports of lapses in quality and protocol at some transplant centers Medicare has undertaken rigorous efforts to review operations and their outcome at all transplant centers in Chicago and nationwide.