Short section of DNA predicts kidney transplant success
A landmark study has narrowed down the genes that best predict long term kidney transplant success, to a small stretch of DNA.
The first study of its kind to gather transplant data from across the UK and Ireland found patients have the best chance of long term survival where the donor and recipient have genetic matches in a section of DNA known as the HLA locus. This finding could help to personalise treatment and reduce costs to the NHS as patients need less treatment or spend less time in hospital.
Led by the National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) at Guy's and St Thomas' NHS Foundation Trust and King's College London, the project aimed to find out how to improve long term success for kidney transplants.
Several genes had previously been thought to predict kidney transplant survival. But now the researchers have shown that it is only the matches in the HLA locus which predict transplant success in the long term.
Every kidney transplant centre in the UK and Ireland contributed anonymised DNA samples (via the UK and Ireland Renal Transplant Consortium), and EU samples were also included in the analysis. Through key collaborations with NHS Blood and Transplant and the Wellcome Sanger Institute, these DNA samples were analysed and linked with transplant and patient survival data.
The painstaking project took over ten years due to the level of collaboration involved, but the researchers believe international initiatives like this are key to improve patient care in the future.
Professor Graham Lord, Director of the NIHR BRC at Guy's and St Thomas', led the study. He said:
"Running a collaboration between so many centres was a real challenge. But it has paid off, as we identified that this area of DNA alone can tell us whether the match between a kidney donor and recipient will work in the long term. This has the potential to improve outcomes for transplant patients and deliver treatments that are more personalised to the health needs of individual patients."
While most genomics studies of this kind use just the data from the recipient or donor alone, this study looked at the data from two genomes – the patient donating the kidney, and the patient receiving it.
The findings suggest that patients could be offered enhanced levels of personalised treatments, along with a reduced need for immunosuppression treatment, and a reduced rate of kidney transplant rejection. Improvements like this could reduce costs to the NHS as patients need less treatment or spend less time in hospital.
This ground breaking study has also provided the platform for future work looking to understand why transplant patients are more susceptible to heart disease and cancer.
The collaboration was made possible by the NIHR Health Informatics Collaboration, which aims to make NHS clinical data more readily available to researchers and the NHS community, for the purpose of improving patient outcomes.
NIHR Biomedical Research Centre at Guy's and St Thomas' Hospital
King's College London
Paper reference: Hernandez-Fuentes MP, Franklin C, Rebollo-Mesa I, et al. Long-and short-term outcomes in renal allografts with deceased donors: A large recipient and donor genome-wide association study. Am J Transplant. 2017;00: 1-10. https://doi.org/10.1111/ajt.14594
Note to editors:
About Professor Graham Lord
- Professor of Medicine and Honorary Consultant in Nephrology, Transplantation and Internal Medicine, Guy's and St. Thomas' Hospital and King's College London, UK(2005-)
- Director of NIHR Biomedical Research Centre, Guy's and St. Thomas' Hospital and King's College London, UK (2012-)
- GMC# 3489873: Specialist Register for Renal Medicine and General (Internal) Medicine June 2003 http://www.lordlab.org
About the NIHR Biomedical Research Centre at Guy's and St Thomas'
The National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) at Guy's and St Thomas' NHS Foundation Trust and King's College London works to develop and deliver new medicines and diagnostics to patients, drive research and innovation into the NHS, and provide national systems leadership for maximum impact to patients.
With our research activity organised into nine themes, each holding an individual Athena Swan Silver award highlighting our commitment to equality and diversity, and supported by our interdisciplinary, world leading infrastructure, we are poised to deliver the next step change for the health and wealth of our nation.
About the NIHR
The National Institute for Health Research (NIHR): improving the health and wealth of the nation through research.
Established by the Department of Health and Social Care, the NIHR:
- funds high quality research to improve health
- trains and supports health researchers
- provides world-class research facilities
- works with the life sciences industry and charities to benefit all
- involves patients and the public at every step
About Guy's and St Thomas' NHS Foundation Trust
Guy's and St Thomas' provides more than 2.4 million patient contacts in acute and specialist hospital services and community services every year. As one of the biggest NHS trusts in the UK, with an annual turnover of almost £1.5 billion, we employ around 15,300 staff. http://www.guysandstthomas.nhs.uk
Guy's and St Thomas' is part of King's Health Partners Academic Health Sciences Centre (AHSC), a collaboration between King's College London, and Guy's and St Thomas', King's College Hospital and South London and Maudsley NHS Foundation Trusts. http://www.kingshealthpartners.org
About Kings College London
King's College London is one of the top 25 universities in the world (2017/18 QS World University Rankings) and among the oldest in England. King's has more than 29,600 students (of whom nearly 11,700 are graduate students) from some 150 countries worldwide, and some 8,000 staff. King's has an outstanding reputation for world-class teaching and cutting-edge research. In the 2014 Research Excellence Framework (REF), eighty-four per cent of research at King's was deemed 'world-leading' or 'internationally excellent' (3* and 4*).
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World-changing ideas. Life-changing impact: https://spotlight.kcl.ac.uk/