Living donor kidney transplantation across positive crossmatch: the University of Illinois at Chicago experience.
BACKGROUND
To increase living donation for kidney transplantation, we investigated desensitization of recipients with positive crossmatch against a potential living donor.


METHODS
Between June 2001 and March 2007, 57 consecutive sensitized candidates for kidney transplantation, with crossmatch positive potential living donors, were treated with various desensitization protocols. All patients received plasmapheresis every other day with intravenous immune globulin 100 mg/kg starting 1 week before the scheduled transplant. Postoperatively, the recipients continued to receive every other day plasmapheresis with intravenous immune globulin for the initial week. Immunosuppression therapy consisted of induction with thymoglobulin and a combination of tacrolimus, mycophenolate, and corticosteroids.


RESULTS
Six patients failed to convert with pretransplant immunomodulation and were not transplanted; 51 underwent live donor kidney transplant. Mean follow-up was 23 months and 36 patients have more than 1-year follow-up. One-year patient and graft survivals were 95% and 93%, respectively. There were 25 episodes of biopsy-proven or clinically presumed rejection in 22 patients in the first year. Of the 17 biopsy-proven episodes, 12 were antibody-mediated rejection and five were acute cellular rejection. Of the patients with antibody-mediated rejection (biopsy proven or empiric), two patients (12%) lost their graft by 1 year. The median modification of diet in renal disease at 6 and 12 months was 55 mL/min (range 9-104 mL/min) and 48 mL/min (range 8-99), respectively.


CONCLUSIONS
Despite increased rejection rates, graft and patient survivals indicate that desensitization of positive crossmatch patients is a reasonable alternative for a sensitized patient who could potentially wait 10 or more years for a suitable cadaveric kidney.
Thielke
James J
JJ
Department of Pharmacy Practice, University of Illinois, Chicago, IL 60612, USA.
West-Thielke
Patricia M
PM
Herren
Heather L
HL
Bareato
Umberto
U
Ommert
Thuy
T
Vidanovic
Vladimir
V
Campbell-Lee
Sally A
SA
Tzvetanov
Ivo G
IG
Sankary
Howard N
HN
Kaplan
Bruce
B
Benedetti
Enrico
E
Oberholzer
Jose
J
D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000188:drug therapy / Q000276:immunology; D001788:Blood Grouping and Crossmatching; D002641:Chicago; D003586:Cytomegalovirus Infections / Q000188:drug therapy / Q000276:immunology; D003888:Desensitization, Immunologic / Q000379:methods; D005260:Female; D005434:Flow Cytometry; D006084:Graft Rejection / Q000276:immunology / Q000401:mortality / Q000517:prevention & control*; D006085:Graft Survival / Q000276:immunology*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology* / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D027601:Polyomavirus Infections / Q000188:drug therapy / Q000276:immunology; D012189:Retrospective Studies; D013601:T-Lymphocytes / Q000276:immunology; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D000890:Anti-Infective Agents; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents