Transplant Accommodation Markers (Version 1)
Research type
Research Study
Full title
Markers of Accommodation in Antibody Incompatible Renal Transplantation
IRAS ID
155179
Contact name
Nizam Mamode
Contact email
Sponsor organisation
Guy's & St. Thomas' Foundation NHS Trust
Research summary
Kidney transplantation offers the best quality of life for people with end-stage kidney failure. In particular, living donor transplantation provides patients with better long-term outcomes than those waiting for a deceased donor transplant. However, up to 20% of patients are found not to be compatible with their potential donors due to antibodies present in their blood.
Antibodies exist in everybody’s blood and form an important part of the body’s defence system against infection. However, some antibodies may react against a transplanted kidney and cause significant damage. The important antibodies in this context are blood group (ABO) and tissue type (HLA). Antibody-Incompatible transplantation refers to transplants performed across blood groups (ABO Incompatible) and across the HLA barrier (HLA Incompatible).
Over the last ten years, progress has been made in overcoming these antibody barriers, thereby increasing the number of patients who can have a transplant. This involves techniques to remove antibodies or to reduce their levels so that transplantation may become possible. Interestingly, antibodies may return following transplantation without causing harm to the kidney. This phenomenon is known as ‘accommodation’. The mechanism whereby this happens is still poorly understood and requires further study of the kidney’s response to antibodies. Some small studies have demonstrated that ‘accommodated’ kidneys have particular proteins on their surface which may be protecting the kidney.
At Guy’s Hospital, we have performed over 150 antibody incompatible transplants and have gained significant experience in taking care of patients undergoing this treatment. We would now like to take a closer look at the process of accommodation by looking again at stored kidney biopsy tissue and performing further tests on these specimens in the laboratory. A better understanding of the accommodation process will be a crucial step in formulating treatments to encourage it to happen, thereby further improving outcomes for all patients.
REC name
London - Westminster Research Ethics Committee
REC reference
14/LO/1270
Date of REC Opinion
15 Jul 2014
REC opinion
Favourable Opinion