Successful simultaneous pancreas kidney transplantation from living-related donor against positive cross-match.
A positive pretransplant flow cytometry cross-match (FC-XM) allows precise identification of high-risk recipients vulnerable to hyperacute or accelerated rejection after transplantation. Living donor kidney transplant recipient candidates with positive cross-match have been successfully treated with a combination of plasmapheresis (therapeutic plasma exchange, TPEX) and intravenous immunoglobulin (IVIG), achieving conversion to negative cross-match and successful transplant. We report the first successful case of simultaneous pancreas kidney transplant (SPKT) from a living donor (LD) performed against an initially positive FC-XM, converted to negative using a protocol based on TPEX and IVIG in combination with antiCD20 monoclonal antibody. This strategy of overcoming the cross-match barriers in living donation may offer a chance of successful transplantation to highly sensitized candidates for SPKT, for whom cadaveric transplant is difficult to achieve.
Sammartino
Cinzia
C
Department of Surgery, Division of Transplantation, University of Illinois at Chicago, Chicago, IL, USA.
Pham
Thuy
T
Panaro
Fabrizio
F
Bogetti
Diego
D
Jarzembowski
Tomasz
T
Sankary
Howard
H
Morelli
Nicola
N
Testa
Giuliano
G
Benedetti
Enrico
E
D000328:Adult; D000911:Antibodies, Monoclonal / Q000737:chemistry; D018951:Antigens, CD20 / Q000276:immunology; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D005260:Female; D005434:Flow Cytometry; D006084:Graft Rejection; D006085:Graft Survival; D006650:Histocompatibility Testing / Q000379:methods*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000628:therapy; D016030:Kidney Transplantation / Q000379:methods*; D019520:Living Donors; D010179:Pancreas; D016035:Pancreas Transplantation / Q000379:methods*; D010956:Plasmapheresis; D014181:Transplantation Immunology
D000911:Antibodies, Monoclonal; D018951:Antigens, CD20; D016756:Immunoglobulins, Intravenous