May 21, 1999 University Of Maryland Doctors Devise Method To Prevent Severe Rejection
Six critically ill people on kidney dialysis have been able to receive a kidney transplant and a new chance at life thanks to a procedure at the University of Maryland Medical Center that cleansed their blood of harmful rejection antibodies.
The success of this innovative procedure, called High PRA Rescue, will be presented at the American Society of Transplant Surgeons annual convention in Chicago on May 19 by Eugene Schweitzer, M.D. It is the first time the procedure has been tried in combination with three new anti-rejection drugs.
"These six patients had loved ones who were willing to give them a kidney, but because of their high PRA, their body would have rejected the new kidney immediately," says Dr. Schweitzer, a transplant surgeon at the University of Maryland Medical Center and associate professor of surgery at the University of Maryland School of Medicine.
High PRA, which stands for "high panel reactive antibody," affects at least 20 percent of people on the U.S. kidney transplant waiting list. It can significantly increase their waiting time to receive a suitable donated kidney. For example, a person with a PRA of 50 means that half of the possible kidneys that became available would be unacceptable. In 1993, patients with a low PRA who received transplants had waited an average of 535 days, while those with the highest PRA waited 1,974 days for a suitable organ.
A person can develop high PRA after having a pregnancy, a previous blood transfusion, or an earlier kidney transplant. High PRA presents a different, much more potent risk of rejection than cell-mediated rejection, which all transplant patients face.
"High PRA can cause immediate rejection of a transplanted kidney, in spite of the powerful anti-rejection medications we have available," says Stephen T. Bartlett, M.D., head of the division of transplant surgery at the University of Maryland Medical Center and professor of surgery and medicine a the University of Maryland School of Medicine.
"We wanted to help these patients to get around that barrier by cleansing their blood of the reactive antibodies," says Dr. Bartlett.
For the procedure, the patients underwent plasmapheresis. They were connected for two hours to a machine that removed their blood, separated out the blood serum that contained the rejection antibodies, and returned their red and white blood cells and platelets. Their serum was replaced by a protein solution. Eight patients had this procedure six times over a two-week period. They also took anti-rejection medication to prevent the antibodies from coming back, using three new drugs: Prograf, Cellcept and IVIG.
The rejection antibodies were successfully removed from six of the eight patients. All six went on to have successful kidney transplants from living donors between March 1998 and April 1999, and the kidneys continue to function. The concept of using plasmapherisis in patients with high PRA has been around since the 1980's, and a few cases had been reported in the U.S. and in Europe, but with low success rates," says Dr. Schweitzer. He believes the new anti-rejection medications that the University of Maryland physicians used in combination with the phasmapherisis made a major difference.
"A year ago, I was hospitalized and severely ill. I had been on dialysis for a year and a half, but my body was deteriorating fast. My husband and I were making final arrangements," says Nancy Peters, 56, from Port Deposit, Md. "My daughter, Aimee, wanted to donate her kidney but because of my high antibody level, I would have rejected it. Doctors at the University of Maryland offered me a chance to get that kidney transplant and it saved my life. I had the transplant on June 4th and I will be forever grateful," says Peters, who adds that she feels good and leads an active life.
"We hope that our success with this procedure will encourage other transplant centers to offer it for their patients, as well," says Dr. Schweitzer.
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