Renal transplantation in patients with positive lymphocytotoxicity crossmatches: one center's experience.
BACKGROUND
Sensitization to human leukocyte antigens remains an important barrier to successful renal transplantation.


METHODS
Herein we describe our center's experience with a plasmapheresis-based desensitization protocol for highly sensitized patients. Twenty-nine patients had a positive T-cell or positive B-cell lymphocytotoxicity crossmatch against their donors. In some cases, baseline crossmatches were of high titer (e.g., 11 had baseline titers > or =1:32).


RESULTS
Twenty-eight of 29 patients were rendered T-cell crossmatch negative and B-cell crossmatch negative/low positive and transplanted. None had hyperacute rejection but 11 (39%) had acute antibody mediated rejection. Median follow-up is 22 months: 25 of the 28 (89%) of allografts are still functioning with mean plasma creatinine 1.5 mg/dL. There was one death because of the transplant or immunsuppression, one case of cytomegalovirus disease and no cases of lymphoproliferative disease.


CONCLUSIONS
This series provides further evidence of the high efficacy of plasmapheresis-based desensitization protocols. Even patients with high baseline crossmatch titers can be successfully desensitized and transplanted. Short- and medium-term outcomes are encouraging but longer-term data are needed.
Magee
Colm C
CC
Renal Division, Brigham and Women's Hospital, Boston, MA 02115, USA. cmagee99@gmail.com
Felgueiras
Joana
J
Tinckam
Kathryn
K
Malek
Sayeed
S
Mah
Helen
H
Tullius
Stefan
S
D000328:Adult; D000368:Aged; D000917:Antibody Formation; D003602:Cytotoxicity, Immunologic; D003888:Desensitization, Immunologic / Q000379:methods*; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control*; D006085:Graft Survival; D006680:HLA Antigens / Q000032:analysis; D006650:Histocompatibility Testing; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000276:immunology / Q000601:surgery / Q000628:therapy*; D016030:Kidney Transplantation / Q000276:immunology*; D008214:Lymphocytes / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D013997:Time Factors; D016896:Treatment Outcome
D006680:HLA Antigens; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents