One of the biggest myths about a kidney transplant is that it’s a cure for kidney failure. A new, healthy kidney–problem solved, right? Alas, that’s hardly the case even though transplant is the gold standard for the “treatment” of kidney failure (far better than dialysis). The better the match, the better the person’s overall health, and the patient’s diligence in safeguarding that kidney, the longer the new kidney will last.
Statistically, that’s an average of 10 to 15 years for a deceased-donor kidney and 15 to 20 for a living-donor kidney. Statistics and averages never give the whole picture, so, fortunately, many kidney recipients have been able to keep their transplant for 25, even 35 years or more.
The National Kidney Registry has a mission not only to increase the number of kidney transplants and improve the matches, but to work toward a long-lasting transplant. Last year I attended a fascinating symposium on important research and developments in donor-recipient matching, sponsored by the National Kidney Donation Organization, or NKDO. Invariably one or two strong takeaways emerge from any important presentation. This time it was a single word and dramatic new concept for me: eplets.
They’re the key to what NKR calls the “Kidney for Life Initiative.”
After the symposium last year I wrote a blog post on this game-changing concept of low-eplet mismatch. The rest of this post is mostly excerpted from that one.
It turns out that compatibility is way more nuanced than I ever imagined. You may have heard about HLA antigens (you know, the 6-out-of-6 match being the so-called “perfect match”?) . Well, apparently, “matching” antigens may look the same, but they differ by their eplet pattern (think of them as “immunologic hot spots”).
Fair warning: I am not a transplant surgeon, a scientist, or a medical writer, so please do not quote me on this. Rather, use the occasion to go ask someone who is–or, better yet, google Kidney for Life.
I’d seen the word eplet on charts and even heard it referenced at the NKR Gala presentations the night before. I got the basic gist from the context, but it wasn’t until Dorry Segev, transplant surgeon at NYU Langone, explained it so well at the symposium that I “got it.” From what I understand, it’s time that potential donors and transplant recipients started using the term, as in “Do you test for eplets?”
Yup, Dr. Segev says “everyone should ask” that before a donation/transplant, so if you’re a donor candidate be sure to add it to your list of questions. Not all transplant centers do the necessary “high-resolution typing” that can see how many eplets are in the antigens. The number of eplet mismatches can make the difference between a kidney transplant that starts to deteriorate months later, and leads to rejection, and one that can conceivably last “for life,” requiring a lower level of immunosuppressants.
Wow–what a potential game changer! Though “eplets” are new to me, and probably to you, they’re hardly new to transplant professionals, who have been studying this “latest generation in DNA sequencing technology” (per the NKR website) for years. Dr. Segev thinks that within about five years, we’ll all be talking about eplets. I know I will and I hope you will too.
If you’re sufficiently intrigued now and wonder if waiting for that “low eplet mismatch” is really worth the wait, here’s Dr. Robert Montgomery, director of NYU Langone’s Transplant Center, explaining why it is worth waiting a little longer for an ideal match.
For related posts, resources, and information on The Insider’s Guide to Living Kidney Donation, be sure to explore the rest of my website.
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