title: Overcoming a positive crossmatch in living-donor kidney transplantation.
abstract: Many patients who have an otherwise acceptable living-kidney donor do not undergo transplantation because of the presence of antibodies against the donor cells resulting in a positive crossmatch. In the current study, 14 patients with a positive cytotoxic crossmatch (titer </= 1 : 16) against their living donor underwent a regimen including pretransplant plasmapheresis, intravenous immunoglobulin, rituximab and splenectomy. Eleven of 14 grafts (79%) are functioning well 30-600 days after transplantation. Two grafts were lost to accelerated vasculopathy and one was lost to death with good function. No hyperacute or cellular rejections occurred. Antibody-mediated rejection occurred in six patients [two clinical (14%) and four subclinical (29%)] and was reversible with plasmapheresis and steroids. Our results suggest that selected crossmatch-positive patients can be transplanted successfully with living-donor kidney allografts, using a protocol of pretransplant plasmapheresis, intravenous immunoglobulin, rituximab and splenectomy. Longer follow-up will be needed, but the absence of anti-donor antibody and good early outcomes are encouraging.
authors.affiliation: Department of Medicine, Division of Nephrology, Mayo Foundation and Clinic, 200 First St SW, Rochester, MN 55905, USA.
authors.forename: James M
authors.initials: JM
authors.lastname: Gloor
authors.forename: Steven R
authors.initials: SR
authors.lastname: DeGoey
authors.forename: Alvaro A
authors.initials: AA
authors.lastname: Pineda
authors.forename: S Breanndan
authors.initials: SB
authors.lastname: Moore
authors.forename: Mikel
authors.initials: M
authors.lastname: Prieto
authors.forename: Scott L
authors.initials: SL
authors.lastname: Nyberg
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Larson
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Griffin
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Textor
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Velosa
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Schwab
authors.forename: Lynette A
authors.initials: LA
authors.lastname: Fix
authors.forename: Mark D
authors.initials: MD
authors.lastname: Stegall
mesh_terms: D000328:Adult; D000906:Antibodies / Q000008:administration & dosage; D000918:Antibody Specificity; D018951:Antigens, CD20 / Q000276:immunology; D005260:Female; D006085:Graft Survival; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D013156:Splenectomy
chemical_list: D000906:Antibodies; D018951:Antigens, CD20; D016756:Immunoglobulins, Intravenous