An article in the Sept. 27 issue of the journal Transplantation has revealed that kidney transplant specialists at Cedars-Sinai Medical Center have developed innovative laboratory techniques to improve opportunities and success rates for kidney transplant candidates who are at high risk of organ rejection because of previous exposure to donor antigens.

Tissue compatibility issues exist for all patients receiving transplanted organs but rejection risk is much greater in those with high exposure to “non-self” human leukocyte antigens (HLAs). Exposure may come through blood transfusions, previous transplantation or even pregnancy, when the mother is exposed to the father’s antigens expressed in the cells of the developing baby. The immune system is then “sensitized” to those antigens, developing antibodies to fend them off even if the antigens arrive in the form of a potentially life-saving donated organ.

Stanley C. Jordan, M.D., medical director of Cedars-Sinai’s Kidney Transplant Program and of the Division of Nephrology, began studying the use of intravenous immunoglobulin (IVIG) 20 years ago as a way to modulate the immune system, “desensitizing” highly sensitized patients to make incompatible organs compatible and reduce rejection risks. IVIG therapy became a Medicare-approved therapy in 2004 when it was found effective in a multicenter study partly funded by the National Institutes of Health.

Jordan and his colleagues also developed laboratory protocols using antigens and patient blood that were useful in predicting which patients were most likely to benefit from desensitization. Now they have adopted new technology – solid phase assays – that uses beads coated with specific HLA antigens to much more precisely determine the specificity and strength of a patient’s antibodies.