title: A high panel-reactive antibody rescue protocol for cross-match-positive live donor kidney transplants.
abstract: BACKGROUND
  Alloimmunization can present a virtually insurmountable barrier to kidney transplantation. Past protocols to desensitize patients using plasmapheresis and cyclophosphamide have not been broadly applied because of the fear of complications, including high rates of immunologic failure.
  
  
  METHODS
  Fifteen patients with a positive donor-recipient cross-match were desensitized with plasmapheresis to permit live donor (LD) transplantation under newer maintenance immunosuppressants. Pretransplant the patients received plasmapheresis three times weekly for a planned maximum of six treatments, plus intravenous hyperimmune globulin, tacrolimus, mycophenolate mofetil, and prednisone. Patients who were successfully desensitized and received transplants were given 10 days of OKT3 postoperatively.
  
  
  RESULTS
  Eleven of the 15 patients became anti-human globulin cross-match-negative after one to five plasmapheresis treatments and underwent LD transplantation. Relatively low initial titers of donor-specific antibody were predictive of successful attainment of a negative cross-match. Few side effects and rejection episodes were observed. All transplant patients remain dialysis-free after 3-26 months of follow-up.
  
  
  CONCLUSIONS
  A positive cross-match is not necessarily a contraindication to LD transplantation, especially for patients with low donor-specific alloantibody titers.
authors: Department of Surgery, University of Maryland, Baltimore, USA. gschweitzer@umm.edu
authors: E J
authors: EJ
authors: Schweitzer
authors: J S
authors: JS
authors: Wilson
authors: M
authors: M
authors: Fernandez-Vina
authors: M
authors: M
authors: Fox
authors: M
authors: M
authors: Gutierrez
authors: A
authors: A
authors: Wiland
authors: J
authors: J
authors: Hunter
authors: A
authors: A
authors: Farney
authors: B
authors: B
authors: Philosophe
authors: J
authors: J
authors: Colonna
authors: B E
authors: BE
authors: Jarrell
authors: S T
authors: ST
authors: Bartlett
mesh_terms: D000328:Adult; D000368:Aged; D000937:Antigen-Antibody Reactions; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006084:Graft Rejection / Q000473:pathology / Q000517:prevention & control; D006650:Histocompatibility Testing; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007518:Isoantibodies / Q000097:blood* / Q000276:immunology*; D016030:Kidney Transplantation / Q000276:immunology; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis
chemical_list: D016756:Immunoglobulins, Intravenous; D007518:Isoantibodies