Kidney desensitization is a process that improves the chances that a donated kidney will not be rejected by the recipient’s body.
White blood cells produce proteins called antibodies that help the body fight infection. The production of antibodies is the body’s first line of defense in the immune response. Antibodies work hard to protect us and keep us healthy.
These same antibodies that protect us from infection may affect how well a kidney transplant functions after the surgery In some cases, a transplant recipient’s body will react to the donated kidney as a foreign tissue and despite the usual immunosuppressive medications,reject the new kidney. Not all recipients produce these types of antibodies. People who produce these antibodies typically develop them through a previous exposure to foreign tissue, such as a prior transplant, blood transfusion, or pregnancy.
A cross-match test is performed between all donors and recipients to ensure that the recipient does not have antibodies in their blood against the donor tissue. These antibodies can cause rejection of the kidney being donated.
A negative result from a cross-match test indicates that the recipient does not have antibodies that would reject the donated kidney the transplant can proceed safely.
A positive result from a cross-match test indicates that the recipient has antibodies that would reject the donated kidney almost immediately and the transplant cannot proceed.
A recipient with a positive cross-match to their intended donor can either wait for or find another donor who has a negative cross-match, participate in the paired kidney exchange program, or undergo the desensitization process.
Your Swedish transplant team will help you weigh your options and help you determine the choice that best fits your situation.
Sometimes in carefully selected recipients, the antibodies that cause a recipient to have a positive cross match with their intended donor can be successfully removed. This is called desensitization. The desensitization process involves a plasma exchange that removes the antibodies against the donor tissue. The number of treatments depends on the amount and type of antibodies a recipient has in their blood. Several treatments are typically required prior to a transplant. Patients are also given anti-rejection medications during the desensitization process to help prevent reformation of the harmful antibodies. These are the same anti-rejection medications used after the transplant.
Currently, only patients with a living donor take part in the desensitization process. The desensitization of the recipient only lasts for a limited amount of time. The time to transplant has to be controlled very closely and this can only be done if a recipient has a living donor already identified. There is no way to anticipate when a deceased donor will become available for a patient on the deceased donor waiting list. Therefore this type of desensitization is not available to patients waiting for a deceased donor kidney.
The transplant team and your transplant coordinator can give you more information on this process and determine whether it is an option for you.