title: Luminex-based desensitization protocols: the University of Wisconsin initial experience.
abstract: BACKGROUND
  We have demonstrated that immunodominant donor-specific antibody (DSA) more than 100 mean fluorescence intensity (MFI) at the time of transplant is associated with a significantly higher risk of rejection. We now present short-term outcomes of DSA-based desensitization (DSZ) strategies in patients with a negative complement-dependent cytotoxicity crossmatch.
  
  
  METHODS
  Between January 1, 2009, and January 1, 2010, live-donor kidney transplant recipients were divided into three protocols based on their immunodominant DSA MFI pretransplant (D1: 100-500, D2: 501-1000, and D3: 1001-3000). Deceased donor kidney transplant recipients were stratified into two protocols (D4: 501-1000 and D5: 1001-3000). The intensity of the conditioning treatment increased with DSA levels and included thymoglobulin induction, plasmapheresis, and intravenous immunoglobulin in the highest risk groups. We compared outcomes between desensitized patients (DSZ) and those undergoing no DSZ (or D0) during the same interval.
  
  
  RESULTS
  Forty-eight of 249 (23%) kidney transplants underwent DSZ (n=20, 4, 3, 4, and 17 in D1-D5 protocols, respectively). There was more retransplantation (50% vs. 18%, P<0.001) and live donor transplantation (56% vs. 30%, P<0.001) in the DSZ group. In this group, mean peak panel reactive antibody and MFI at transplant were 51% ± 7% and 960 ± 136, respectively. The incidence of antibody-mediated rejection (25% vs. 12.5%, P=0.008) and acute cellular rejection (23% vs. 14%, P=0.02) was greater in the DSZ group. However, mixed rejection (8%), graft loss (0 vs. 6), patient death (0 vs. 3), cytomegalovirus infection (15% vs. 12%), and 1-year serum creatinine (1.4 ± 0.5 and 1.4 ± 0.4 mg/dL) were similar between DSZ and no-DSZ groups. CONCLUSION.: Long-term follow-up is needed to determine the role of Luminex-based strategies in current preconditioning regimens.
authors.affiliation: Department of Surgery, University of Wisconsin, Madison, WI, USA.
authors.forename: Silke V
authors.initials: SV
authors.lastname: Niederhaus
authors.forename: Brenda
authors.initials: B
authors.lastname: Muth
authors.forename: David F
authors.initials: DF
authors.lastname: Lorentzen
authors.forename: Philip
authors.initials: P
authors.lastname: Wai
authors.forename: John D
authors.initials: JD
authors.lastname: Pirsch
authors.forename: Milagros
authors.initials: M
authors.lastname: Samaniego-Picota
authors.forename: Glen E
authors.initials: GE
authors.lastname: Leverson
authors.forename: Anthony M
authors.initials: AM
authors.lastname: D'alessandro
authors.forename: Hans W
authors.initials: HW
authors.lastname: Sollinger
authors.forename: Arjang
authors.initials: A
authors.lastname: Djamali
mesh_terms: D000328:Adult; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D002985:Clinical Protocols; D005260:Female; D006650:Histocompatibility Testing; D006785:Hospitals, University; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007518:Isoantibodies / Q000097:blood / Q000302:isolation & purification; D016030:Kidney Transplantation / Q000276:immunology* / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D012189:Retrospective Studies; D014019:Tissue Donors; D019172:Transplantation Conditioning / Q000379:methods*; D016896:Treatment Outcome; D014922:Wisconsin
chemical_list: D000961:Antilymphocyte Serum; D016756:Immunoglobulins, Intravenous; D007518:Isoantibodies; C512542:thymoglobulin