In complex cases of kidney failure, medical care in Germany evidently operates better than in the US. Scientists at Charité – Universitätsmedizin Berlin were able to show that German patients who have an increased risk of rejection reactions due to prior immunization have better survival rates than people with diseases of similar severity in the US. This applies not only during dialysis but also to the period after receiving a new kidney. The researchers regard the reasons for this as being not only the better quality of dialysis in Germany but particularly a highly efficient European organ donation system, with the aid of which data of organ donors and recipients are recorded, analyzed and thus optimally assigned to suitable patients. The results of the study were published in a “Letter to the Editor” in the “New England Journal of Medicine”*.
Some people on the waiting list for a new kidney suffer from a prior immunization event, so-called HLA sensitization. This can occur after pregnancies or with recipients of blood donations. In the blood, antibodies form against tissue characteristics, which make it difficult for the body to accept transplants from certain donors. Studies show a very high rejection rate for donor organs if the patient is sensitized to HLA. Scientists at the Johns Hopkins University had endeavored to remove the antibodies from the blood of HLA-sensitized patients by replacing the blood plasma, so-called plasmapheresis. In conjunction with increased suppression of the immune system this complex procedure initially leads to successful transplantation in these patients but it presents further risks for the patient: Almost 10 percent of patients treated in this way died during the first year following transplantation while 80 percent were still alive after five years. By comparison, the data obtained at Charité shows that even without plasmapheresis about 90 percent of transplant recipients with similar demographic data were still alive after five years. In light of these figures, Prof. Klemens Budde, a senior doctor at the Medical Department, Division of Nephrology, Campus Charité Mitte, regards such desensitization programs as “unnecessary.” He says that procedures like the “acceptable mismatch program” in Europe, where in an elaborate procedure the best donor in each case is sought for the sensitized patients on the waiting list, are far more suitable for high-risk patients. Due to the improved tissue compatibility less intensive suppression of the immune system is adequate, as a result of which there are fewer side effects.
Taking a look at dialysis patients on the waiting list also indicates better medical care in Germany than in the US. In this group almost nine percent of US patients died during the first year while 34 percent had died after five years. By comparison, in Berlin and Brandenburg about 90 percent of dialysis patients on the waiting list at Charité were still alive after five years. “Taking a look at the US draws our attention to the weaknesses of the American healthcare system. We should guard against implementing such programs in Europe,” says Prof. Budde, summing up in an article published in “Deutsches Ärzteblatt”.
*Huber L, Naik M, Budde K. Desensitization of HLA-incompatible kidney recipients. N Engl J Med. 2011 Oct 27;365(17):1643; author reply 1644-5. PubMed PMID: 22029992.
Prof. Klemens Budde
Medizinische Klinik mit Schwerpunkt Nephrologie
Campus Charité Mitte
t: +49 30 450 514 002