Desensitization for renal transplantation: depletion of donor-specific anti-HLA antibodies, preservation of memory antibodies, and clinical risks.
Desensitization protocols reduce donor-specific anti-HLA antibodies (DSA) and enable renal transplantation in patients with a positive complement-dependent cytotoxic cross-match (CDC-CXM). The effect of this treatment on protective antibody and immunoglobulin levels is unknown. Thirteen patients with end-stage renal disease, DSA and positive CDC-CXM underwent desensitization. Sera collected pre- and post-transplantation were analysed for anti-tetanus and anti-pneumococcal antibodies, total immunoglobulin (Ig) levels and IgG subclasses and were compared to healthy controls and contemporaneous renal transplant recipients treated with standard immunosuppression alone. Ten patients developed negative CDC-CXM and enzyme-linked immunosorbent assay (ELISA) and underwent successful transplantation. Eight recipients achieved good graft function without antibody-mediated or late rejection, BK virus or cytomegalovirus infection. One patient had primary non-function due to recurrent oxalosis, and one patient with immediate graft function died from septicaemia. Seven recipients required post-operative transfusion and three developed septicaemia. DSA remained negative by ELISA at 12 months, but were detectable by Luminex(®) . Anti-tetanus and anti-pneumococcal antibodies, total Ig and IgG subclasses were below the normal range but comparable to levels in renal transplant recipients who had not undergone desensitization. Desensitization protocols effectively reduce DSA and allow successful transplantation. Post-operative bleeding and short-term infectious risk is increased. Protective antibody and serum immunoglobulin levels are relatively preserved.
Rogers
Natasha M
NM
Central Northern Adelaide Renal and Transplantation Services, The Royal Adelaide Hospital, Adelaide, SA, Australia.
Eng
Hooi S
HS
Yu
Raymond
R
Kireta
Svjetlana
S
Tsiopelas
Eleni
E
Bennett
Greg D
GD
Brook
Nicholas R
NR
Gillis
David
D
Russ
Graeme R
GR
Coates
P Toby
PT
D000328:Adult; D000368:Aged; D000906:Antibodies / Q000276:immunology*; D000907:Antibodies, Bacterial / Q000276:immunology; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D000077552:Basiliximab; D003888:Desensitization, Immunologic / Q000379:methods*; D005260:Female; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis; D007156:Immunologic Memory / Q000276:immunology*; D007165:Immunosuppression Therapy / Q000379:methods; D007676:Kidney Failure, Chronic / Q000276:immunology*; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D011239:Prednisolone / Q000627:therapeutic use; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use; D013296:Streptococcus pneumoniae / Q000276:immunology; D016559:Tacrolimus / Q000627:therapeutic use; D013742:Tetanus / Q000276:immunology; D014019:Tissue Donors
D000906:Antibodies; D000907:Antibodies, Bacterial; D000911:Antibodies, Monoclonal; D006680:HLA Antigens; D007074:Immunoglobulin G; D011993:Recombinant Fusion Proteins; D000077552:Basiliximab; D011239:Prednisolone; D009173:Mycophenolic Acid; D016559:Tacrolimus