Wednesday, 26 November 2008

'Two for the price of one' tactic improves outcomes after organ transplantation

A new study of more than a million transplant recipients has found that rejection rates are lower in patients who receive two organs at once than in those who receive a single organ.

The study, published in Annals of Surgery, found that the rejection rates for organs cotransplanted with a donor-specific liver, heart or kidney were significantly lower than those for organs transplanted alone.

It has been known for some time that transplanting a liver with another organ such as a kidney or a section of intestine reduces the likelihood of rejection of the primary organ, leading to the suggestion that liver allografts protect other organs from rejection. Combined liver and kidney transplantation is used in patients with hepatorenal syndrome - in which acute kidney failure occurs as a result of liver cirrhosis or fulminant liver failure - or in patients with end-stage renal disease who also have liver damage as a result hepatitis B or C virus infection. Simultaneous intestine and liver transplantation is used in patients with intestinal failure following the removal of a large section of intestine (e.g. because of a tumor) and end-stage liver disease, which may be due to receiving their meals intravenously following intestine removal (total parenteral nutrition).

The recent study by Rana et al. has revealed that heart and kidney allografts are also immunoprotective and are themselves protected when transplanted with another organ.

The authors searched the United Network for Organ Sharing database – which contains data about every transplant that has taken place in the US since 1986 – and identified all thoracic, kidney, intestine and liver transplant recipients over 18 years old.

In patients who simultaneously received heart and kidney transplants from a single deceased donor, the incidences of renal allograft rejection and cardiac allograft rejection at one year were lower than in patients who received either a heart or a kidney allograft alone. In addition, the rate of rejection-free survival at one year was higher in the combined organ recipients. Likewise, compared with patients who received a single organ, rejection of either organ and rejection-free survival were lower and higher, respectively, in individuals who received combined liver and kidney transplants.

On the other hand, cotransplantation of intestine or pancreas in patients undergoing kidney or liver transplantation did not lower the risk of rejection or improve rejection-free survival.

The authors suggest that combined simultaneous organ transplantation could be used more widely to reduce rejection rates and lower the need for immunosuppression in transplant recipients.
Rana A et al. (2008) The Combined Organ Effect: Protection Against Rejection? Annals of Surgery 248 (5): 871-879 DOI: 10.1097/SLA.0b013e31817fc2b8

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