Largest study of its kind to date
Professor Bentall said previous research has typically focused on transplant success rates and types of kidney rejection, but this study is the largest to date and shows that even if the kidneys are functioning, It is said to be the most detailed study of why patients die regardless of the circumstances.
Currently, standardized treatment is built around a prescription of immunosuppressive drugs that patients take daily to reduce the risk of organ rejection. Ninety-nine percent of kidney transplants are successful after one year, which is a significant improvement from the success rate of about 30 to 50 percent 30 years ago, before anti-rejection drugs were developed, Bentall said. To tell.
But these drugs come with a range of complications, including high blood pressure, weight gain, and an increased risk of infections and some cancers. National Kidney Foundation.
Please keep this in mind. National Institute of Diabetes and Digestive and Kidney Diseases The most common causes of kidney disease in Americans are diabetes and high blood pressure, which means patients are often already battling these chronic diseases.
Bentall found that age 55 is the dividing line between younger and older transplant patients. Younger patients are at increased risk of renal rejection and may benefit from increased doses of immunosuppressants. Older patients are at risk of dying from cancer and urinary tract, lung, and viral infections and may benefit from lower levels of immunosuppressants.
“People’s immune systems weaken as they age, and they take immunosuppressive drugs, which increases the risk of infections. Older people have a harder time fighting infections,” Bentall says.
Elderly patients also need care that focuses on lifestyle changes that address obesity, hypertension, and diabetes, whether or not these are chronic conditions that the patient had before the transplant.
Bentall said he hopes this research will lead to personalized approaches that treat these two populations differently.
“In medicine, it’s important to make decisions based on data rather than intuition. Numbers and figures are important to patients because they say, ‘We looked at patients like you, and you have problems in these areas.’ “They’re more likely to be affected, but they can make these specific changes to improve outcomes,” he says.
“The key message is to talk to your doctor and ask what immunosuppressive treatment options are best for you. [as you go] “The interest in transplantation and how we can change the medical risk profile to get better outcomes,” Bentall said.
The researchers said the study should be used as a “starting point” for front-line doctors caring for kidney transplant patients. Hannah Carr, MDa kidney and pancreas transplant surgeon at the Cleveland Clinic in Ohio.
“I definitely agree that perhaps immunosuppression may be more commonly reduced in older patients,” she says. “We spend a lot of time monitoring for complications with anti-rejection drugs.”
Dr Kerr said patients will need to pass pre-transplant tests including weight and overall health, but post-transplant there will be “even more emphasis” on these factors when adjusting to drugs that can have strong side effects. said it was necessary.
Immunosuppressants as the “holy grail”
Dr. Fasika M. TedraThe study’s findings are “valuable,” said the nephrologist and director of renal transplantation at the Recanati Miller Transplant Institute at Mount Sinai Medical Center in New York City. He said he was verifying it.
He said immunosuppressive drugs are the “holy grail” of transplantation, but the transplant community is working to better understand how to tailor the intensity of treatment to each patient.
“This brings up the same old question of how to individualize immunosuppression. It’s a difficult balance, but we have to rely on what we know from existing trials and We have to follow up with patients and adjust accordingly,” says Dr. Tedra.
Even in the face of guesswork and real-time tweaking, the field has come a long way, Tedra says.
“I would like to tell patients and their families that the overall trajectory of outcomes for patients undergoing kidney transplants continues to improve, despite the limitations. Kidney transplants over dialysis “It’s clear that patients have better health, better quality of life, and better survival rates,” he says.
