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The Power of Hope: Redefining Treatment Decisions for Highly Sensitized Kidney Patients

A new study explored what matters most to highly sensitized kidney transplant patients when deciding between chronic dialysis and desensitization-enabled HLA-incompatible kidney transplantation. The findings reveal a strong preference for transplantation, driven by their hope of receiving a new kidney. Presented at the 2025 World Transplant Congress in San Francisco, these insights highlight the importance of better understanding patient preferences to ensure treatment options truly reflect their values and priorities.

Highly sensitized patients account for approximately 10-15 percent1,2 of the patients on the transplant waiting lists in the US and Europe. Due to their immunological profiles, they face prolonged – often indefinite– waiting times on waiting lists and disproportionately high mortality.3,4

Desensitization treatment can enable HLA-incompatible kidney transplantation, offering highly sensitized patients a chance to receive a life-changing transplant and free themselves from chronic dialysis. As these medical advancements expand treatment options, it is essential to understand what matters most to patients when making treatment decisions. To explore this Hansa Biopharma sponsored a Discreet Choice Experiment (DCE) in partnership with the American Association of Kidney Patients (AAKP) Center for Patient Research and Education and conducted by Syneos Health.

The study interviewed 99 highly sensitized end-stage kidney disease (ESKD) patients to identify the factors influencing their choice between remaining on dialysis or proceeding with same-day desensitization followed by an HLA-incompatible kidney transplant.

A strong desire to receive a transplant organ, in the hope of receiving a new kidney and improving quality of life

The results show that nearly all participants (97 out of 99) expressed a willingness to proceed with same day desensitization followed by HLA-incompatible transplantation. While they were aware that an HLA-incompatible organ might not last as long as a compatible one, their decisions were primarily driven by the hope of receiving a new kidney and having the same opportunity for transplantation as others on the waiting list.

“To inform the design of the study, we identified five key attributes - hope, risk, life participation, kidney survival, and support - through a combination of literature review, focus groups and one-on-one interviews with patients, insights from healthcare professionals, and our collaboration with AAKP”, explained Geoffrey Gray Insights & Measurement Strategist, Syneos Health.

“What stood out most was the emergence of hope as a new and previously unrecognized attribute. Remarkably, hope became the most influential factor in participants’ decision-making. These patients demonstrated a profound will to live and a strong belief that HLA-incompatible transplantation could offer them a significantly better quality of life” continued Geoffrey.

Kidney survival was another important factor in patients’ decision-making, with many recognizing that a same-day desensitization-enabled transplant may not last as long as a compatible kidney. Still, they were willing to accept this risk in exchange for the potential to regain greater participation in life.

“This study reinforces just how vital it is to listen to patients,” said Jennifer Leonard, Director US Field Clinical Research and Medical Affairs, Hansa Biopharma. “Their perspectives offer invaluable insight into what truly matters when facing complex treatment decisions. By understanding their preferences, we can support more meaningful conversations between patients and healthcare providers and ensure that treatment options reflect what patients value most.”

Collaboration across the continuum of care to improve equity for highly sensitized people in kidney transplantation

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Driving equity of treatment through patients’ preference

Highly sensitized kidney transplant patients have historically relied on dialysis for extended and often indefinite time, with very low chances of receiving a compatible transplantation due to their immunological profile. Recent advancements in desensitization treatment promise to offer new opportunities for these patients to receive a long-awaited life-changing transplant.

The results of this Discrete Choice Experiment study show that given the opportunity, highly sensitized patients are willing to explore innovative options in the hope of obtaining an equal opportunity when being offered a new kidney, while being aware of the potential risks. Yet, it also indicates that only 61% of the participants had ever discussed desensitization with their doctor—highlighting a gap in communication and awareness.

At Hansa we are committed to develop treatment solutions that bring meaningful change for patients. To achieve this, we must ensure the patient voice is embedded in decisions about their care, and that current and future treatment options truly reflect their preferences and hopes. The insights from this study will guide our efforts to work with the healthcare and patient communities to ensure highly sensitized patients are able to access optimal care and are empowered to make informed choices with their doctors.

References

  1. Jordan SC, et al. Imlifidase Desensitization in Crossmatch-positive, Highly Sensitized Kidney Transplant Recipients: Results of an International Phase 2 Trial (Highdes). Transplantation. 2021 Aug 1;105(8):1808-1817. doi: 10.1097/TP.0000000000003496.
  2. Organ Procurement and Transplantation Network (OPTN) and Scientific Registry of Transplant Recipients (SRTR). OPTN/SRTR 2022 Annual Data Report. U.S. Department of Health and Human Services, Health Resources and Services Administration; 2024.
  3. Alelign T, Ahmed MM, Bobosha K, Tadesse Y, Howe R, Petros B. Kidney Transplantation: The Challenge of Human Leukocyte Antigen and Its Therapeutic Strategies. J Immunol Res. 2018 Mar 5;2018:5986740. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5859822/
  4. Heidt S, et al. Highly Sensitized Patients are Well Serves by Recieving a Compatible Organ Offer Based on Acceptable Mismatches. Front Immunol. 2021;12:687254. Available at: https://pubmed.ncbi.nlm.nih.gov/34248971/