image: Professor of medicine and surgery at the University of Pittsburgh School of Medicine, and senior transplant nephrologist at UPMC. view more
Credit: UPMC
EMBARGOED FOR RELEASE UNTIL 5 P.M. ET, WEDNESDAY, AUG. 18, 2021
PITTSBURGH, Aug. 18, 2021 – Long-term survival rates of kidney transplant patients in the U.S. have increased over the last three decades, but there are opportunities to further improve these outcomes, according to a review article published today in The New England Journal of Medicine.
For many patients with end-stage kidney disease, transplants are a better option than a lifetime of dialysis. But some kidney grafts will fail eventually. Prolonging the survival time of kidney grafts not only improves patient lifespan, boosts quality of life and reduces health care costs, but it also means that more kidneys are available for the approximately 90,000 people who are waiting for a transplant in the U.S.
“There has been a gratifying improvement in kidney transplant survival, both for patients and the kidney graft itself, from 1996 to the current era,” said the review’s lead author, Sundaram Hariharan, M.D., professor of medicine and surgery at the University of Pittsburgh School of Medicine, and senior transplant nephrologist at UPMC. “These improvements have occurred despite unfavorable increases in obesity, diabetes and other conditions in patients and donors.”
The article—coauthored by Ajay Israni, M.D., transplant nephrologist at Hennepin Healthcare, and a professor of medicine at the University of Minnesota, and Gabriel Danovitch, M.D., transplant nephrologist and professor of medicine at the University of California, Los Angeles, who contributed equally to the review—describes these positive trends in the U.S. and suggests opportunities to further enhance kidney transplant survival.
Kidney transplantation involves grafting a healthy kidney from a deceased or living donor, who is carefully screened to ensure they are compatible with the recipient. To help prevent their bodies from rejecting the new organ, transplant patients must take immunosuppressive drugs for the rest of their lives.
The study found that long-term survival of kidney grafts has increased over time. For example, the five-year survival rate of kidneys from deceased donors increased from 66.2% in 1996–1999 to 78.2% in 2012–2015. Similarly, survival of those from living donors increased from 79.5% to 88.1% in the same period.
“We have learned a lot through research and by taking care of kidney transplant patients,” said Hariharan. “Newer tissue typing and tissue matching platforms, changes in organ allocation systems, living donor paired exchanges, transplant surgical techniques, immunosuppressive medications, anti-viral medications, refined diagnostic methods of kidney rejection by biopsy, aggressive post-transplant surveillance and overall post-transplant medical management have contributed to better survival rates.”
The researchers emphasize that COVID-19 is a serious threat to kidney transplant recipients, and mortality rates from the disease are high in these people. COVID-19 vaccines can help reduce the rate and severity of infections, but they are less effective in transplant patients compared with the general population. A third, or “booster,” dose of the vaccine may be beneficial for these people.
“It’s also very important that kidney transplant patients follow Centers for Disease Control and Prevention guidelines on social distancing and masking,” said Hariharan.
Despite advances in kidney transplant survival, the U.S. rates fall short of those in other developed nations. This is likely because Medicare insurance covers immunosuppressant drugs for just three years after transplantation.
But in December 2020, a new U.S. law was passed that will eventually provide lifetime coverage of these essential medications.
“The passing of this law is a great victory for kidney transplant patients, and we anticipate further improvements in long-term kidney transplant survival over the next decade,” said Hariharan.
The article outlines other opportunities to further enhance kidney graft survival, such as early referral of patients for transplants, kidney exchange programs, better diagnostic tools to identify early acute rejection, innovative therapies for both T-cell- and antibody-mediated rejection, adoptive T-cell therapy for certain post-transplant viral infections and optimization of immunosuppressive medications.
Better education of patients about the importance of adhering to therapy also is important for improving transplant survival. According to Hariharan, a silver lining of the COVID-19 pandemic has been wider adoption of telemedicine, expanding patient access to post-transplant care.
To read this release online or share it, visit https://www.upmc.com/media/news/081821-kidney-transplant-survival [when embargo lifts].
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About the University of Pittsburgh School of Medicine
As one of the nation’s leading academic centers for biomedical research, the University of Pittsburgh School of Medicine integrates advanced technology with basic science across a broad range of disciplines in a continuous quest to harness the power of new knowledge and improve the human condition. Driven mainly by the School of Medicine and its affiliates, Pitt has ranked among the top 10 recipients of funding from the National Institutes of Health since 1998. In rankings recently released by the National Science Foundation, Pitt ranked fifth among all American universities in total federal science and engineering research and development support.
Likewise, the School of Medicine is equally committed to advancing the quality and strength of its medical and graduate education programs, for which it is recognized as an innovative leader, and to training highly skilled, compassionate clinicians and creative scientists well-equipped to engage in world-class research. The School of Medicine is the academic partner of UPMC, which has collaborated with the University to raise the standard of medical excellence in Pittsburgh and to position health care as a driving force behind the region’s economy. For more information about the School of Medicine, see www.medschool.pitt.edu.
About UPMC’s transplant programs
UPMC’s transplant programs are among the world’s largest and are internationally renowned for their influence on the field of transplantation. For more than 30 years, UPMC has provided care to adult and pediatric transplant patients through the Thomas E. Starzl Transplantation Institute, the UPMC Department of Cardiothoracic Surgery, the UPMC Heart and Vascular Institute, and the Children’s Hillman Center for Pediatric Transplantation. Today, UPMC has performed more than 20,000 transplants, including heart, lung, intestinal, kidney, liver, pancreas and multiple-organ transplants, along with heart assist device implantation. A pioneer in the development and refinement of new transplant procedures, UPMC is committed to reducing waiting list deaths through robust living-donor kidney and living-donor liver transplant programs, as well as other innovative methods to expand the donor pool. UPMC also partners with the University of Pittsburgh to advance basic science and clinically applied research, as well as to support the teaching and training of transplant specialists worldwide.
Contact: Asher Jones
Mobile: 412-639-6222
E-mail: JonesAG@upmc.edu
Contact: Andrea Kunicky
Office: 412-692-6254
Mobile: 412-552-7448
E-mail: KunickyA@upmc.edu
Journal
New England Journal of Medicine