Successful renal transplantation with desensitization in highly sensitized patients: a single center experience.
Intravenous immunoglobulin (IVIG) and/or plasmapheresis (PP) are effective in preventing antibody-mediated rejection (AMR) of kidney allografts, but AMR is still a problem. This study reports our experience in living donor renal transplantation in highly sensitized patients. Ten patients with positive crossmatch tests or high levels of panel-reactive antibody (PRA) were included. Eight patients were desensitized with pretransplant PP and low dose IVIG, and two were additionally treated with rituximab. Allograft function, number of acute rejection (AR) episodes, protocol biopsy findings, and the presence of donor-specific antibody (DSA) were evaluated. With PP/IVIG, six out of eight patients showed good graft function without AR episodes. Protocol biopsies revealed no evidence of tissue injury or C4d deposits. Of two patients with AR, one was successfully treated with PP/IVIG, but the other lost graft function due to de novo production of DSA. Thereafter, rituximab was added to PP/IVIG in two cases. Rituximab gradually decreased PRA levels and the percentage of peripheral CD20+ cells. DSA was undetectable and protocol biopsy showed no C4d deposits. The graft function was stable and there were no AR episodes. Conclusively, desensitization using PP/IVIG with or without rituximab increases the likelihood of successful living donor renal transplantation in sensitized recipients.
Yoon
Hye Eun
HE
Division of Nephrology, Department of Internal Medicine, Kangnam St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Hyoung
Bok Jin
BJ
Hwang
Hyeon Seok
HS
Lee
So Young
SY
Jeon
Youn Joo
YJ
Song
Joon Chang
JC
Oh
Eun-Jee
EJ
Park
Sun Cheol
SC
Choi
Bum Soon
BS
Moon
In Sung
IS
Kim
Yong Soo
YS
Yang
Chul Woo
CW
D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20 / Q000096:biosynthesis; D005260:Female; D006801:Humans; D007136:Immunoglobulins / Q000378:metabolism; D016130:Immunophenotyping; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007518:Isoantibodies / Q000737:chemistry; D007676:Kidney Failure, Chronic / Q000628:therapy; D016030:Kidney Transplantation / Q000379:methods*; D008214:Lymphocytes / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000069283:Rituximab
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D007136:Immunoglobulins; D007166:Immunosuppressive Agents; D007518:Isoantibodies; D000069283:Rituximab