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Significance of blood group and HLA antibodies in kidney transplantation
AG Morath
The best therapy for patients with chronic kidney failure is the transplantation of a donor kidney. However, even if blood group and tissue characteristics match, the immune system of the organ recipient is able to recognize the donor kidney as foreign and develop an immune response against it. Transplanted patients must therefore take immunosuppressive medication for the rest of their lives.
Nevertheless, the donor organ is rejected in more than ten percent of patients within the first three years. Antibodies that are specifically directed against certain surface characteristics (so-called human leukocyte antigens - HLA) of the donor organ play a decisive role in the rejection reaction. Some patients already have antibodies against HLA characteristics of the future donor before the transplantation, and the body's defense reaction is then particularly strong.
These patients benefit from a therapy concept developed in Heidelberg to desensitize the immune system. The central component of this desensitization is immunoadsorption to remove harmful HLA antibodies from the patient's blood.
The subsequent administration of rituximab, a drug that targets antibody-producing immune cells - the so-called B lymphocytes - prevents the formation of new antibodies.
This procedure is currently being further developed as part of a project funded by the Dietmar Hopp Foundation. So far, more than 60 patients with a very high risk of rejection have been pre-treated for living donation in Heidelberg in this way. After one year, around 95 percent of the transplants are still functioning. The results now correspond to those of patients without antibodies and therefore without an increased risk.
The new therapy concept is now also used in cases of blood group incompatibility between donor and recipient, as well as for transplants of other organs.
Preparations are currently underway to test these therapy methods in multi-center studies. Another focus of the work is the search for markers that can predict a rejection reaction against the donor organ in advance. Studies have shown that among the numerous types of antibodies that occur in every human being, there are certain variants that promote rejection reactions that are difficult to suppress.
Studies are being carried out in the blood and in tissue from biopsies of transplanted organs.
Project management
Prof. Dr. med. C. Morath
christian_morath@med.uni-heidelberg.de
+49 6221 9112 0
Persons involved
Dr. med. Luis Eduardo Becker
Dr. med. Katrin Klein
Dr. med. Sebastian Schäfer
Dr. med. Jörg Beimler
Prof. Dr. med. Vedat Schwenger
Prof. Dr. med. Martin Zeier
Iris Arnold, MTA
Anke Wollschläger, BTA
Partner
Cooperation with the Department of Transplantation Immunology at the UKL-Heidelberg, the Department of Transplantation Surgery at the UKL-Heidelberg and the Institute of Pathology at the University of Heidelberg
Prof. Caner Süsal, MD, Transplant Immunology
Prof. Gerhard Opelz, MD, Transplant Immunology
Prof. Peter Schemmer, MD, Transplant Surgery
Prof. Rüdiger Waldherr, MD, Pathology
Dr. Stefan Macher-Göppinger, MD, Pathology