title: Peritransplant immunoadsorption for positive crossmatch deceased donor kidney transplantation.
abstract: Various desensitization protocols were shown to enable successful living donor kidney transplantation across a positive complement-dependent cytotoxicity crossmatch (CDCXM). Positive crossmatch transplantation, however, is less well established for deceased donor transplantation. We report a cohort of 68 deceased donor renal allograft recipients who, on the basis of broad sensitization (lymphocytotoxic panel reactivity ≥40%), were subjected to a protocol of peritransplant immunoadsorption (IA). Treatment consisted of a single session of immediate pretransplant IA (protein A) followed by posttransplant IA and antilymphocyte antibody therapy. Twenty-one patients had a positive CDCXM, which could be rendered negative by pretransplant apheresis. Solid phase HLA antibody detection revealed preformed donor-specific antibodies (DSA) in all 21 CDCXM-positive and in 30 CDCXM-negative recipients. At 5 years, overall graft survival, death-censored graft survival and patient survival were 63%, 76% and 87%, respectively, without any differences between CDCXM-positive, CDCXM-negative/DSA-positive and CDCXM-negative/DSA-negative recipients. Furthermore, groups did not differ regarding rates of antibody-mediated rejection (24% vs. 30% vs. 24%, p = 0.84), cellular rejection (14% vs. 23% vs. 18%, p = 0.7) or allograft function (median 5-year serum creatinine: 1.3 vs. 1.8 vs. 1.7 mg/dL, p = 0.62). Our results suggest that peritransplant IA is an effective strategy for rapid desensitization in deceased donor transplantation.
authors.affiliation: Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria.
authors.forename: G
authors.initials: G
authors.lastname: Bartel
authors.forename: M
authors.initials: M
authors.lastname: Wahrmann
authors.forename: H
authors.initials: H
authors.lastname: Regele
authors.forename: Z
authors.initials: Z
authors.lastname: Kikić
authors.forename: G
authors.initials: G
authors.lastname: Fischer
authors.forename: W
authors.initials: W
authors.lastname: Druml
authors.forename: F
authors.initials: F
authors.lastname: Mühlbacher
authors.forename: G A
authors.initials: GA
authors.lastname: Böhmig
mesh_terms: D000293:Adolescent; D000328:Adult; D001788:Blood Grouping and Crossmatching; D002102:Cadaver; D015331:Cohort Studies; D003888:Desensitization, Immunologic; D005260:Female; D006084:Graft Rejection / Q000628:therapy; D006801:Humans; D007163:Immunosorbent Techniques; D007165:Immunosuppression Therapy; D016030:Kidney Transplantation / Q000276:immunology*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011300:Preoperative Care; D016896:Treatment Outcome; D055815:Young Adult