Highly successful and low-cost desensitization regime for sensitized living donor renal transplant recipients.
10-30% of dialysis population awaiting renal transplantation is sensitized. Present desensitization protocols use intravenous immune globulins, rituximab, and plasmapheresis in various combinations; however, these regimens are unaffordable by many in developing countries. We tried desensitization with mycophenolate mofetil and plasmapheresis. Methods. Patients with high PRA titre (> or =50%) or positive crossmatch (>10%) were treated with MMF for a month before proposed transplant and were given five sittings of plasmapheresis. Results. 11 of 12 patients had normalization of PRA/crossmatch with this regimen and were successfully transplanted. One patient lost the graft due to graft vein thrombosis, and two patients died within three months after transplant due to septicemia and pulmonary embolism, respectively, with a functioning graft. No patient, including the two who died, developed clinical rejection over a mean follow-up of 10 months (range 1-16 months). Mean serum creatinine at last follow up was 1.1 mg/dL (range 0.9-1.3 mg/dL). Conclusions. Though the number of patients studied is small, we feel that highly sensitized patients awaiting living donor renal transplant should be tried on this simple and cost-effective regime before transplant. The more aggressive and expensive approaches incorporating IVIg and rituximab should be used only if this relatively low-cost regime is unsuccessful.
Army Hospital (R&R), Delhi Cantt, New Delhi, 110010, India.
Prem P
PP
Varma
Ashok K
AK
Hooda
Arun
A
Kumar
Lavan
L
Singh
D000328:Adult; D015331:Cohort Studies; D003131:Combined Modality Therapy; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003888:Desensitization, Immunologic / Q000191:economics / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006650:Histocompatibility Testing; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D016030:Kidney Transplantation / Q000276:immunology* / Q000379:methods / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*; D010956:Plasmapheresis / Q000379:methods*; D011300:Preoperative Care; D014181:Transplantation Immunology; D016896:Treatment Outcome; D014850:Waiting Lists; D055815:Young Adult
D009173:Mycophenolic Acid