An integrative approach for the transplantation of high-risk sensitized patients.
BACKGROUND
Sensitized patients have a lower chance of receiving a crossmatch-negative kidney and, if transplanted, are at risk of antibody-mediated allograft rejection.


METHODS
For safe and timely transplantation of sensitized patients at our center, we developed an integrative algorithm that includes identification of high-risk patients, good human leukocyte antigen match, inclusion in the Eurotransplant Acceptable Mismatch Program when applicable, apheresis, anti-CD20 therapy, posttransplant antibody monitoring, and protocol biopsies. Thirty-four high-risk recipients of a deceased donor kidney (DDK: n=28) or living donor kidney (LDK: n=6) were transplanted using this algorithm.


RESULTS
One-year graft survival, death-censored graft survival, and patient survival rates in DDK recipients were 92.4%, 96.4%, and 95.8%, respectively. No graft loss or patient death was observed in the six LDK patients. Median serum creatinine at 1 year in DDK and LDK recipients was 1.2 and 1.4 mg/dL, respectively. Eleven DDK and three LDK patients experienced at least one biopsy-proven acute rejection episode, mostly showing borderline changes. Antibody-mediated rejection without graft loss was diagnosed in two DDK and one LDK patients. Delayed graft function was observed in 13 DDK and 1 LDK patients. Infectious complications were infrequent.


CONCLUSIONS
We describe an algorithm for the categorization and treatment of presensitized high-risk patients. This protocol provides effective prevention of antibody-mediated rejection and is associated with a low rate of side effects and good graft outcome.
Morath
Christian
C
Department of Nephrology, University of Heidelberg, Heidelberg, Germany. christian.morath@med.uni-heidelberg.de
Beimler
Jörg
J
Opelz
Gerhard
G
Ovens
Jörg
J
Scherer
Sabine
S
Schmidt
Jan
J
Schmied
Bruno
B
Gross
Marie-Luise
ML
Schwenger
Vedat
V
Zeier
Martin
M
Süsal
Caner
C
D000328:Adult; D000368:Aged; D000906:Antibodies / Q000276:immunology; D002102:Cadaver; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D006085:Graft Survival / Q000276:immunology*; D006650:Histocompatibility Testing / Q000379:methods; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007258:Informed Consent; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology*; D007902:Length of Stay; D008875:Middle Aged; D012307:Risk Factors; D014019:Tissue Donors; D014184:Transplantation, Homologous; D055815:Young Adult
D000906:Antibodies; D007166:Immunosuppressive Agents