New Procedure Allows Kidney Transplants From Any Donor
腎臟移植出現(xiàn)重大突破，配型不合不再是問(wèn)題

In the anguishing wait for a new kidney, tens of thousands of patients on waiting lists may never find a match because their immune systems will reject almost any transplanted organ. Now, in a large national study that experts are calling revolutionary, researchers have found a way to get them the desperately needed procedure.

移植排隊(duì)名單上成千上萬(wàn)的患者痛苦地等待著匹配的腎源，但他們很可能永遠(yuǎn)等不到那一天——因?yàn)樗麄兊拿庖呦到y(tǒng)會(huì)排斥幾乎所有移植器官。而今，在一項(xiàng)被專家們譽(yù)為“具有革命性意義的”大型全國(guó)性研究中，研究人員找到了一種方法可以滿足這些迫切需要手術(shù)的患者。

In the new study, published Wednesday in The New England Journal of Medicine, doctors successfully altered patients’ immune systems to allow them to accept kidneys from incompatible donors. Significantly more of those patients were still alive after eight years than patients who had remained on waiting lists or received a kidney transplanted from a deceased donor.

這項(xiàng)周三（3月9日）發(fā)表在《新英格蘭醫(yī)學(xué)雜志》(The New England Journal of Medicine)上的新研究稱，醫(yī)生們成功地改造了患者的免疫系統(tǒng)，使得他們可以接受配型不合的供體腎。8年后，這些患者的存活率顯著高于仍在排隊(duì)等待移植或接受了已故供者腎移植的患者。

The method, known as desensitization, “has the potential to save many lives,” said Dr. Jeffery Berns, a kidney specialist at the University of Pennsylvania’s Perelman School of Medicine and the president of the National Kidney Foundation.

賓夕法尼亞大學(xué)佩爾蒙醫(yī)學(xué)院(University of Pennsylvania’s Perelman School of Medicine)的腎病專家，美國(guó)腎臟病基金會(huì)(National Kidney Foundation)主席杰弗里·伯恩斯(Jeffery Berns)說(shuō)，這種被稱為“脫敏”(desensitization)的方法“有望挽救許多人的生命”。

It could slash the wait times for thousands of people and for some, like Clint Smith, a 56-year-old lawyer in New Orleans, mean the difference between receiving a transplant and spending the rest of their lives on dialysis.

它可以減少數(shù)千人的等待時(shí)間，而且，對(duì)于像新奧爾良的56歲律師克林特·史密斯(Clint Smith)一類的患者，它意味著接受移植與終生透析的差別。

The procedure, Mr. Smith said, “changed my life.”

史密斯先生說(shuō)，這個(gè)療法“改變了我的人生”。

Researchers estimate about half of the 100,000 people in the United States on waiting lists for a kidney transplant have antibodies that will attack a transplanted organ, and about 20 percent are so sensitive that finding a compatible organ is all but impossible. In addition, said Dr. Dorry Segev, the lead author of the new study and a transplant surgeon at the Johns Hopkins University School of Medicine, an unknown number of people with kidney failure simply give up on the waiting lists after learning that their bodies would reject just about any organ. Instead, they resign themselves to dialysis, a difficult and draining procedure that can pretty much take over a person’s life.

研究人員估計(jì)，在美國(guó)排隊(duì)等待腎移植的10萬(wàn)名患者中，有約一半帶有會(huì)攻擊移植器官的抗體，有約20%的人非常敏感，以至于幾乎不可能找到匹配的器官。此外，這項(xiàng)新研究的主要作者，約翰斯·霍普金斯大學(xué)醫(yī)學(xué)院(Johns Hopkins University School of Medicine)的移植外科醫(yī)生多莉·塞格夫(Dorry Segev)博士說(shuō)，還有數(shù)目不詳?shù)哪I功能衰竭患者在得知他們的身體會(huì)排斥基本上所有的移植器官之后，干脆放棄了等待移植，將就地去接受透析——一種幫人排出體內(nèi)多余水分的費(fèi)事做法，一旦接受透析，患者的整個(gè)生活幾乎都將受制于它。

Desensitization involves first filtering the antibodies out of a patient’s blood. The patient is then given an infusion of other antibodies to provide some protection while the immune system regenerates its own antibodies. For some reason — exactly why is not known — the person’s regenerated antibodies are less likely to attack the new organ, Dr. Segev said. But if the person’s regenerated natural antibodies are still a concern, the patient is treated with drugs that destroy any white blood cells that might make antibodies that would attack the new kidney.

“脫敏”療法大致如下：首先過(guò)濾出患者血液中的抗體。然后為患者注入其他抗體，這樣，在患者免疫系統(tǒng)重新生成抗體的過(guò)程中就可以得到一定的保護(hù)。塞格夫博士說(shuō)，出于某種確切機(jī)制尚不清楚的原因，患者新產(chǎn)生的抗體攻擊移植器官的可能性減小了。不過(guò)，如果重生的天然抗體仍然影響移植，就需要用藥物破壞掉所有能合成抗體攻擊新腎臟的白細(xì)胞。

The process is expensive, costing $30,000, and uses drugs not approved for this purpose. The transplant costs about $100,000. But kidney specialists argue that desensitization is cheaper in the long run than dialysis, which costs $70,000 a year for life.

該療法十分昂貴，費(fèi)用高達(dá)3萬(wàn)美元，而且相關(guān)藥物并未獲批用于此目的。移植費(fèi)用約為10萬(wàn)美元。但腎病專家指出，從長(zhǎng)遠(yuǎn)來(lái)看，“脫敏”還是比透析（一年的費(fèi)用約為7萬(wàn)美元）更為合算。

Although by far the biggest use of desensitization would be for kidney transplants, the process might be suitable for living-donor transplants of livers and lungs, researchers said. The liver is less sensitive to antibodies so there is less need for desensitization, “but it’s certainly possible if there are known incompatibilities,” Dr. Segev said. With lungs, he said, desensitization “is theoretically possible,” although he said he was not aware of anyone doing it yet.

研究人員表示，雖然目前“脫敏”的最大用途是腎臟移植，該療法很可能也適用于肝臟和肺的活體移植。肝臟對(duì)抗體較不敏感，所以對(duì)“脫敏”的需求較少，“但如果出現(xiàn)配型不合的問(wèn)題，用“脫敏”來(lái)治療當(dāng)然有其可能性，”塞格夫博士說(shuō)。對(duì)于肺，他認(rèn)為脫敏“在理論上可行”，不過(guò)他表示自己并不知道有什么人在進(jìn)行這方面的嘗試。

In the new study, 1,025 patients at 22 medical centers who had an incompatible donor were compared to an equal number of patients who remained on waiting lists for an organ or who had an organ from a deceased but compatible donor. After eight years, 76.5 percent of those who received an incompatible kidney were still alive, compared with 62.9 percent who remained on the waiting list or received a deceased donor kidney and 43.9 percent who remained on the waiting list but never got a transplant.

在前面提到的新研究中，研究人員將22個(gè)醫(yī)療中心的1025名與供者配型不合的患者與相同數(shù)量的等待移植和接受了已故供者配型一致的器官的患者進(jìn)行了比較。8年后，接受不匹配腎移植的患者中，存活率為76.5%，相比之下，在等待移植并接受已故供者腎移植的患者中為62.9%，而在一直等待但未能接受移植的患者中為43.9%。

The desensitization procedure takes time — for some patients as long as two weeks — and is performed before the transplant operation, so patients must have a living donor. It is not known how many have someone willing to donate a kidney, but doctors say they often see situations in which a relative or even a friend is willing to donate but is incompatible.

“脫敏”療法必須在移植手術(shù)之前進(jìn)行，且需要一定時(shí)間——某些病人甚至需要兩周，這決定了患者必須擁有一位活體供者。目前尚不清楚有多少人愿意捐腎，但醫(yī)生們說(shuō)，他們經(jīng)常遇到親屬或朋友愿意捐獻(xiàn)，結(jié)果配型不合的情況。

“Often patients are told that their living donor is incompatible, so they are stuck on waiting lists,” for a deceased donor, Dr. Segev said.

塞格夫博士說(shuō)，“很多時(shí)候，患者被告知他們的活體供者和他們不匹配，所以他們只能繼續(xù)等啊等”，直到出現(xiàn)匹配的已故供者。

In recent years, an option called a kidney exchange has helped some in this situation. Patients who have incompatible living donors can swap donors with someone whose donor may be compatible with them. Often, there are chains of patient-donor pairs leading to a compatible organ swap.

近年來(lái)，腎臟交換移植計(jì)劃(kidney exchange)為解決此類困境提供了一定的幫助。該方案鼓勵(lì)擁有配型不合的活體供者的患者們互換供者。數(shù)個(gè)這樣的“患者-供者”對(duì)首尾相接，往往最終可以令每名患者都獲得匹配的供者。

That process can be successful, said Dr. Krista L. Lentine, the medical director of the living donation program at the Saint Louis Center for Transplantation, but patients often still cannot find a compatible organ because they have antibodies that would reject almost every kidney. In those cases, “desensitization may be the only realistic option for receiving a transplant,” said Dr. Lentine, who was not involved with the study.

該方案有可能成功，圣路易斯移植中心(Saint Louis Center for Transplantation)活體捐贈(zèng)計(jì)劃的醫(yī)務(wù)主任克里什陶·L·朗坦(Krista L. Lentine)博士說(shuō)，但很多時(shí)候，患者仍然無(wú)法找到匹配的器官，因?yàn)樗麄凅w內(nèi)的抗體會(huì)令他們排斥幾乎所有的腎臟。在這種情況下，“脫敏恐怕是想要移植者的唯一現(xiàn)實(shí)選擇”，朗坦博士說(shuō)道。她并沒(méi)有參與前述新研究。

Dr. Jeffrey Campsen, a transplant surgeon at the University of Utah Health Sciences Center who also was not a study investigator, said his group focused on exchanges and had been fairly successful. But he also comes across patients whose donors do not want to participate. “There is a hurdle if the donor and patient have an emotional bond,” he said.

猶他大學(xué)健康科學(xué)中心(University of Utah Health Sciences Center)的移植外科醫(yī)生杰弗里·坎普森(Jeffrey Campsen)博士也沒(méi)有參與該研究，他表示他團(tuán)隊(duì)的工作以交換移植方案為主，并已經(jīng)取得了相當(dāng)?shù)某晒?。但他也遇到過(guò)患者的供者不愿意參與交換的情況?！叭绻┱吲c患者之間存在感情紐帶，就會(huì)造成障礙，”他說(shuō)。

The new data showing the success of desensitization “l(fā)ets people get behind it,” Dr. Campsen said, adding, “I do think it is something we would consider.”

新的數(shù)據(jù)顯示了“脫敏”的成功，“這使得人們得以越過(guò)上述障礙，”坎普森博士說(shuō)，“我覺(jué)得我們應(yīng)該予以考慮?！?/p>

Mr. Smith, the New Orleans patient who went through desensitization, had progressive kidney disease that slowly scarred his kidneys until, in 2004, they stopped functioning. His sister-in-law, Allison Sutton, donated a kidney to him, and he had a transplant, but after six and a half years, it failed. He went on dialysis, spending four days a week hooked up to dialysis machines for hours. It was keeping him alive, he told his friends, but it was not a life.

新奧爾良的患者史密斯先生接受了“脫敏”治療。他患有退行性腎病(progressive kidney disease)，病魔慢慢地侵蝕他的腎臟，令它傷痕累累，以致在2004年徹底失去了功能。他的嫂子艾莉森·薩頓(Allison Sutton)給他捐獻(xiàn)了一個(gè)腎，但遺憾的是，六年半之后，移植還是失敗了。他只好繼續(xù)接受透析，每周四天里都有數(shù)小時(shí)困在透析機(jī)上。他告訴朋友們，雖然保住了命，但這種日子根本不算是“生活”。

Then a nurse suggested that he ask Johns Hopkins about its desensitization study. “I was like, whatever I could do,” he said. He discovered that he qualified for the study. But he needed a donor.

后來(lái)，一名護(hù)士建議他去打聽(tīng)打聽(tīng)約翰斯·霍普金斯大學(xué)的“脫敏”研究。“當(dāng)時(shí)我回答，只要我做得到，怎樣都行，”他說(shuō)。他發(fā)現(xiàn)他符合參與研究的資格，只是他需要一個(gè)供者。

One day, Mrs. Smith was talking on the phone to a college friend, Angela Watkins, who lives in Augusta, Ga., and mentioned that Mr. Smith was praying for a donor. Mrs. Watkins’s husband, David Watkins, a judge in state court, had been friends with Mr. Smith in college and the two wives, also college friends, had kept in touch over the years.

有一天，史密斯夫人在跟大學(xué)時(shí)的朋友，住在佐治亞州奧古斯塔的安杰拉·沃特金斯(Angela Watkins)通電話時(shí)提到了史密斯先生期待能找到一個(gè)供者。沃特金斯夫人的丈夫戴維·沃特金斯(David Watkins)是州法院的法官，他跟史密斯先生在大學(xué)時(shí)代是朋友，兩位妻子也一樣，而且她們多年來(lái)一直保持著聯(lián)系。

Mrs. Watkins told her husband about the conversation, and they asked themselves if they should offer to donate.

沃特金斯夫人把談話內(nèi)容告訴了丈夫，他們都在心里掂量著是否應(yīng)捐腎給史密斯先生。

“We talked and researched and prayed,” Judge Watkins said. Finally, he said, they came to a conclusion. “We have a moral obligation to at least see if we would qualify.” And he thought that he should be the one to go first. If he did not qualify, his wife could be tested.

沃特金斯法官說(shuō)：“我們討論、研究和祈禱?！弊詈?，他們得出了一個(gè)結(jié)論?！拔覀冎辽賾?yīng)該去看看是否有資格捐獻(xiàn)，這是道義上的責(zé)任?！彼f(shuō)。而且他認(rèn)為自己應(yīng)該先去。如果不合格了才輪到妻子去接受測(cè)試。

Mr. Smith warned his old friend that donating was an enormous undertaking. “He said, ‘You can’t grasp what you are doing.’ I heard him but it didn’t register,” Judge Watkins said. “I told him, ‘I have something you need, so what’s the big deal?’ ”

史密斯先生告誡自己的老朋友捐腎可不是件小事。“他說(shuō)：‘你根本不知道自己在做什么。’”沃特金斯法官說(shuō)，“不過(guò)我并沒(méi)有把他的話放在心上。我跟他說(shuō)：‘我不過(guò)是正好擁有你需要的東西罷了，這有什么大不了的？’”

Of course, it was a big deal. Although Judge Watkins had prepared by getting himself in top physical shape, it still took about six months to recover from the operation.

不，捐腎當(dāng)然是件大事。雖然沃特金斯法官做好了準(zhǔn)備，讓自己的身體處于最佳狀態(tài)，但他還是花了大約6個(gè)月的時(shí)間才從手術(shù)中恢復(fù)過(guò)來(lái)。

That was four years ago, and Mr. Smith’s new kidney is still functioning and he is back to his active life, forever grateful to his friend.

四年過(guò)去了。至今，史密斯先生的新腎臟仍在正常地發(fā)揮著生理機(jī)能，他又回到了充滿活力的生活當(dāng)中，并對(duì)他的朋友永遠(yuǎn)心懷感激。

“Every night.” he says, “during my nightly prayers with my wife, I thank God for bringing David and Allison to me and for giving me the gift of life.

他說(shuō)：“每天晚上我和妻子做晚間祈禱的時(shí)候，我都感謝上帝將戴維和艾莉森，將生命的禮物賜予了我。

”But for David giving me this gift, I would still be in that dialysis chair.”

“若不是戴維的禮物，我到現(xiàn)在還困在透析椅上呢?！?/p>