title: Successful deceased donor renal transplant in a sensitized pediatric recipient with the use of plasmapheresis.
abstract: Sensitization following renal transplant is a significant barrier to repeat transplantation in children. We report a successful DD renal transplant, with the use of PP, in an 11-yr-old girl who became highly sensitized following a prior failed transplant. She received PP treatments after failure of high-dose IVIg (Gamimune). We established the effectiveness of PP by attaining a 0% PRA and negative cross-matches after five PP treatments. Subsequently, our patient underwent a second round of scheduled PP. When the PRA was 0%, unacceptable antigens were removed from the UNOS wait list, PP was continued, and a kidney became available within 10 days. The final flow cytometry cross-match with the eventual donor was negative. This success demonstrates that coordination of desensitization by PP and advanced laboratory monitoring techniques with recent policies regarding allocation of organs to pediatric patients provides new opportunities for children awaiting transplantation. Since the transplant, our patient sustained a low-titer increase of anti-HLA antibodies. However, she has had no episodes of acute rejection and has maintained excellent graft function more than 17 months later.
authors.affiliation: Division of Nephrology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA 19104, USA. pradhan@email.chop.edu
authors.forename: Madhura
authors.initials: M
authors.lastname: Pradhan
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Raffaelli
authors.forename: Curt
authors.initials: C
authors.lastname: Lind
authors.forename: Kevin E C
authors.initials: KE
authors.lastname: Meyers
authors.forename: Bernard S
authors.initials: BS
authors.lastname: Kaplan
authors.forename: Hobart J
authors.initials: HJ
authors.lastname: Baluarte
authors.forename: Dimitri
authors.initials: D
authors.lastname: Monos
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D002648:Child; D005260:Female; D006680:HLA Antigens / Q000737:chemistry; D006650:Histocompatibility Testing / Q000379:methods; D006801:Humans; D007136:Immunoglobulins / Q000008:administration & dosage; D016130:Immunophenotyping; D007262:Infusions, Intravenous; D007668:Kidney / Q000473:pathology; D016030:Kidney Transplantation / Q000379:methods*; D010372:Pediatrics / Q000379:methods*; D010956:Plasmapheresis; D000069283:Rituximab; D013927:Thrombosis; D009927:Tissue and Organ Procurement
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D006680:HLA Antigens; D007136:Immunoglobulins; D000069283:Rituximab