Kidney transplantation in sensitized recipients; a single center experience.
A successful transplantation, across a positive crossmatch barrier, is one of the most persistent long-standing problems in the field of kidney transplant medicine. The aim of this study was to describe seven consecutive living renal transplantations in recipients with positive crossmatch for donors or positive for donor specific antibodies (DSAs). A preconditioning regimen including plasmapheresis and intravenous immunoglobulin was delivered three times a week until the crossmatch and/or DSAs became negative. Mycophenolate mofetil and tacrolimus were started two days before the plasmapheresis. The protocol was modified to include administration of anti-CD 20 antibody (rituximab, 375 mg/m(2)) from the patient number 3 through the patient number 7. All seven patients achieved negative conversion of the crossmatch or DSAs, and the kidney transplantations were successfully performed in all cases. Acute cellular rejection occurred in two patients, which were subclinical and controlled with high dose steroid treatment. Antibody-mediated rejection occurred in one patient, which was easily reversed with plasmapheresis. All recipients attained normal graft function during the 7-24 months of follow up. Our study suggests that sensitized patients can be transplanted successfully with desensitization pretreatment.
Kim
Sun Moon
SM
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Lee
Chungsik
C
Lee
Jung Pyo
JP
Kim
Eun Man
EM
Ha
Jongwon
J
Kim
Sang Joon
SJ
Park
Myoung Hee
MH
Ahn
Curie
C
Kim
Yon Su
YS
D000328:Adult; D000911:Antibodies, Monoclonal / Q000494:pharmacology; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20 / Q000096:biosynthesis; D001706:Biopsy; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006650:Histocompatibility Testing / Q000379:methods; D006801:Humans; D007136:Immunoglobulins / Q000737:chemistry; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D000069283:Rituximab; D019172:Transplantation Conditioning
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D007136:Immunoglobulins; D000069283:Rituximab