Paired kidney exchange offers hope to minority patients waiting for transplants

As a transplant surgeon and director of the George Washington University Transplant Institute, I have a special interest is in trying to get as many patients as possible kidney transplants. Patients who receive kidney transplants live a much longer life and are generally much happier than patients who remain on dialysis.

We currently have an epidemic of kidney disease in the United States primarily due to a huge increase in the incidence of diabetes and high blood pressure, the two leading causes of kidney disease. There are five stages of kidney disease and once you enter into stage five, you must receive some sort of renal replacement therapy. This would be either some form of dialysis or you could receive a kidney transplant.

Certain groups of patients are harder to transplant because they build up proteins (antibodies) in their blood that would cause their bodies to attack a new kidney transplant. Pregnancies, blood transfusions, certain types of infections, prior transplants and various other reasons can cause these proteins to build up in the blood.

Once these proteins or antibodies are formed in people's blood, special procedures must be done by transplant doctors in order to either remove the antibodies or avoid kidney donors whose kidneys would be attacked by those antibodies.

One of the simplest ways to avoid any problems due to rejection of a transplant is to avoid an interaction between a patient’s antibodies that would react against a donor’s kidney. A paired kidney exchange in its simplest form is really just exchanging a live kidney donor that you know for someone that you don't know, who was unable to donate to their friend or loved one because of incompatibility.

In other words, if you have a kidney donor who has a different blood type, they could give their kidney to someone else with the same blood type while that other person’s donor of your blood type can then give their kidney to you; this is a paired kidney exchange.

Paired kidney exchanges can be dramatic. In 2010, I was part of a team that performed a 32-person swap—a new record at the time. Very few paired exchanges involve that many people, but they all have one thing in common—more than one person who needs a kidney receives one.

These daisy chains, or kidney swaps, offer hope for patients living with end-stage renal disease. Nearly 100,000 people currently are on the kidney transplant list and we only perform 22,000 transplants every year. By utilizing a combination of fancy new medications and paired kidney exchange, we can increase the number of transplants performed by 1,000-2,000 per year, and we are well on our way to meeting that goal.

Paired exchanges are especially helpful in finding matching kidneys for minority patients who tend to have higher levels of antibodies in their blood. Minority patients tend to spend a longer period of time on hemodialysis, causing their bodies to create more proteins (antibodies). It is for this particular reason that I have focused my interest upon helping this group of patients receive kidney transplants.

We in the transplant world have to be particularly concerned about the welfare of our African-American patients because they are 4–5 times more likely to develop kidney disease and therefore require dialysis or kidney transplants. When I started to focus on trying to increase access to kidney transplantation for minority patients, it became obvious to me that we would have to come up with ways to deal with the buildup of these antibodies.

That’s why I am such an advocate for paired exchanges. By facilitating paired kidney exchanges, we vastly increase the number of kidney transplants that are done in this country and we can make kidneys available even for hard-to-match patients.

As I stated earlier, kidney transplant is a life-changing therapy for patients with end stage renal disease, so we must do everything we can to get these patients who are on the transplant list transplanted.

Dr. Melancon is the director of the GW Transplant Institute and a professor of surgery at The George Washington University Hospital. He presented a free webinar on paired donation and increasing minority transplants in the American Kidney Fund’s monthly webinar series. View it on the AKF website.

Posted: | Author: Joseph Keith Melancon, M.D.

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