title: Successful kidney transplantation in highly sensitized patients.
abstract: Highly sensitized patients experience an increased number of rejection episodes and have poorer graft survival rates; hence, sensitization is a significant barrier to both access to and the success of organ transplantation. This study reports our experience in kidney transplantation in highly sensitized patients. Fourteen patients with sensitization or high levels of panelreactive antibodies (PRA) were studied. All patients were desensitized with pre-transplant intravenous immunoglobulin (IVIG)/plasmapheresis (PP) with or without rituximab and thymoglobulin induction therapy, combined with a Prograf/MMF/Pred immunosuppressive regimen. Of 14 patients, 10 showed good graft functions without acute rejection (AR) episodes. Acute cellular rejection in two patients was reversed by methylprednisolone. Two patients underwent antibody-mediated rejection; one was treated with PP/IVIG successfully, whereas the other lost graft functions due to the de novo production of donor-specific antibodies (DSA). Graft functions were stable, and there were no AR episodes in other patients. Conclusively, desensitization using PP/IVIG with or without rituximab increases the likelihood of successful live-donor kidney transplantation in sensitized recipients.
authors.affiliation: Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Key Laboratory of Organ Transplantation, Ministry of Education and Ministry of Health, Wuhan, 430030, China.
authors.forename: Weijie
authors.initials: W
authors.lastname: Zhang
authors.forename: Dong
authors.initials: D
authors.lastname: Chen
authors.forename: Zhishui
authors.initials: Z
authors.lastname: Chen
authors.forename: Fanjun
authors.initials: F
authors.lastname: Zeng
authors.forename: Changsheng
authors.initials: C
authors.lastname: Ming
authors.forename: Zhengbin
authors.initials: Z
authors.lastname: Lin
authors.forename: Ping
authors.initials: P
authors.lastname: Zhou
authors.forename: Gang
authors.initials: G
authors.lastname: Chen
authors.forename: Xiaoping
authors.initials: X
authors.lastname: Chen
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D003888:Desensitization, Immunologic / Q000379:methods*; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy / Q000276:immunology* / Q000628:therapy; D006085:Graft Survival / Q000187:drug effects / Q000276:immunology*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage; D007155:Immunologic Factors / Q000008:administration & dosage; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D016030:Kidney Transplantation / Q000276:immunology* / Q000379:methods; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives; D010956:Plasmapheresis; D012189:Retrospective Studies; D000069283:Rituximab; D016559:Tacrolimus / Q000008:administration & dosage
chemical_list: D000893:Anti-Inflammatory Agents; D058846:Antibodies, Monoclonal, Murine-Derived; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D000069283:Rituximab; D009173:Mycophenolic Acid; D016559:Tacrolimus; D008775:Methylprednisolone