Efficacy of a negative conversion trial and subsequent living donor kidney transplant outcome in recipients with a positive lymphocyte crossmatch.
BACKGROUND
Patients with a positive lymphocyte crossmatch (LCX) do not undergo kidney transplantation. In such patients, a negative conversion protocol consisting of intravenous immunoglobulin (IVIG), plasmapheresis, and potent immunosuppressant is one of the options for transplantation.


METHODS
14 patients who showed a positive LCX with living donors underwent a trial of negative conversion between January 2002 and July 2007. Plasmapheresis was performed every other day, up to 6 times maximum. IVIG was infused after plasmapheresis, with a total dose of 500 mg/kg divided over 6 days. Kidney transplantation was performed immediately after negative conversion. Anti-thymocyte globulin (ATG) or OKT3 induction therapy was used with the combination of tacrolimus, mycophenolate mofetil, and prednisone in the perioperative period.


RESULTS
Negative conversion of LCX was achieved in 13 of 14 patients (92.9%). Transplantations were performed successfully in these 13 patients without hyperacute rejection. Four recipients developed acute rejection, which was well controlled by steroid pulse therapy. During the follow-up periods of 45.4 +/- 22.0 months, all recipients except 1 showed excellent graft function.


CONCLUSIONS
Selected patients with a positive LCX can undergo successful transplantation using plasmapheresis, IVIG, and potent immunosuppressants. Recipients with negative conversion of LCX showed acceptable posttransplant results.
Huh
Kyu Ha
KH
Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
Kim
Soon Il
SI
Joo
Dong Jin
DJ
Ju
Man Ki
MK
Chang
Hye Kyung
HK
Kim
Hae Jin
HJ
Kim
Yu Seun
YS
Kim
Myoung Soo
MS
D000328:Adult; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D001402:B-Lymphocytes / Q000276:immunology; D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000517:prevention & control; D006650:Histocompatibility Testing; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007165:Immunosuppression Therapy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007518:Isoantibodies / Q000097:blood*; D016030:Kidney Transplantation / Q000276:immunology*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D016853:Muromonab-CD3 / Q000627:therapeutic use; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D010956:Plasmapheresis; D011241:Prednisone / Q000008:administration & dosage / Q000627:therapeutic use; D011292:Premedication; D011300:Preoperative Care / Q000379:methods*; D012086:Reoperation; D013601:T-Lymphocytes / Q000276:immunology; D016559:Tacrolimus / Q000008:administration & dosage / Q000627:therapeutic use; D014184:Transplantation, Homologous / Q000276:immunology*; D016896:Treatment Outcome
D000961:Antilymphocyte Serum; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D007518:Isoantibodies; D016853:Muromonab-CD3; D009173:Mycophenolic Acid; D011241:Prednisone; D016559:Tacrolimus