Have you had a prior transplant? Multiple pregnancies? Blood transfusions? If you are on a transplant list, has your transplant center reported to you that you have high levels of antibodies? Do you know what antibodies treatment options are available?
If you answered “yes” to any of these questions and are not sure what this means or what you can do about it, here is some information to help you out. If you have high levels of antibodies, you may have been told that it will be hard to get a donor match or that there isn’t any treatment out there to help you. Here is a bit of good news; leading hospitals such as Cedars-Sinai Medical Center, Johns Hopkins Hospital and The Mayo Clinic have published studies that show there is hope and that you can increase your chances of a successful transplant with antibodies treatment options. This treatment is called desensitization.A person can become sensitized as a result of exposures to other human tissues such as blood transfusions, pregnancies or prior transplants. If you have elevated antibodies, know that you are not alone. Approximately 3 out of 10 people on the national waiting list are sensitized. As of February 15, 2011 the United Network for Organ Sharing (UNOS) reported that there are 87,939 people waiting on the national waiting list for a kidney transplant and approximately 25,000 of those people have antibodies high enough to be a problem matching with a donor.
Antibodies are proteins the body makes to defend itself, like an army in our body that fights off foreign tissue; for example: a new kidney. An army is good for fighting enemies like infections but not so good if you need a transplant. This army can attack and reject a kidney transplant immediately (this is called acute rejection).
You may have heard of treatment called Intravenous Immunoglobulin, referred to as I.V.I.G, that helps with antibodies. If you were to look up this medication you would see that it can also be given to people with autoimmune diseases or people who have a lot of infections. That is because IVIG has antibodies in it to help people fight off infection. This is not why we use IVIG in transplant. IVIG can help decrease the ability of the army of antibodies your body has made to engage and fight off foreign tissue, like a kidney transplant. In simple terms, IVIG can weaken the reaction of the antibodies (soldiers in the army) that would fight off a kidney transplant.
This is considered the standard of care for antibody treatment. Dr. Stanley C. Jordan from Cedars-Sinai has been studying IVIG for over 20 years and has published its effects and how it can help improve the chances of a successful transplant for people who have high antibodies.
IVIG modifies the immune system without suppressing it. In addition to IVIG at Cedars-Sinai, we add a drug call Rituxan which blocks cells which produce antibodies (or soldiers that are part of this army that fight off foreign tissue).
Plasmapheresis can also be used for treatment. This is a procedure where your blood goes through a machine and the plasma where these antibodies are circulating is removed.
These treatments can be used if you are on the national waiting list or if you have a potential living donor who wants to give you a kidney. IVIG and other desensitization treatment options have also lead hospitals such as Cedars-Sinai, to be able to perform blood type incompatible transplants. That means that if your living donor is not the same blood type or is incompatible with your blood type, you may be able to get your transplant with the use of medication like IVIG, Rituxan and Plasmapheresis.
If you are wondering if you have antibodies, ask your transplant center what your PRA (panel reactive antibody) level is. If it is above 30, ask if you need treatment such as IVIG or desensitization.
About the Author
Kristen Cisneros is a Kidney and Pancreas Transplant Coordinator at Cedars-Sinai Medical Center. Kristen currently specializes as their Transplant Immunotherapy Program Nurse Coordinator. Kristen has worked in Transplant for over 10 years including ICU, critical care at Johns Hopkins Hospital and UCLA Medical Centers. She is an active triathlete and is scheduled to run the LA Marathon in March.
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