title: Living donor kidney transplantation in crossmatch-positive patients enabled by peritransplant immunoadsorption and anti-CD20 therapy.
abstract: Living donor kidney transplantation in crossmatch-positive patients is a challenge that requires specific measures. Ten patients with positive crossmatch results (n = 9) or negative crossmatch results but strong donor-specific antibodies (DSA; n = 1) were desensitized using immunoadsorption (IA) and anti-CD20 antibody induction. IA was continued after transplantation and accompanied by HLA antibody monitoring and protocol biopsies. After a median of 10 IA treatments, all patients were desensitized successfully and transplanted. Median levels of mean fluorescence intensity (MFI) of Luminex-DSA before desensitization were 6203 and decreased after desensitization and immediately before transplantation to 891. Patients received a median of seven post-transplant IA treatments. At last visit, after a median follow-up of 19 months, 9 of 10 patients had a functioning allograft and a median Luminex-DSA of 149 MFI; serum creatinine was 1.6 mg/dl, and protein to creatinine ratio 0.1. Reversible acute antibody-mediated rejection was diagnosed in three patients. One allograft was lost after the second post-transplant year in a patient with catastrophic antiphospholipid syndrome. We describe a treatment algorithm for desensitization of living donor kidney transplant recipients that allows the rapid elimination of DSA with a low rate of side effects and results in good graft outcome.
authors.affiliation: Department of Nephrology, University of Heidelberg, Heidelberg, Germany. christian.morath@med.uni-heidelberg.de
authors.forename: Christian
authors.initials: C
authors.lastname: Morath
authors.forename: Jörg
authors.initials: J
authors.lastname: Beimler
authors.forename: Gerhard
authors.initials: G
authors.lastname: Opelz
authors.forename: Sabine
authors.initials: S
authors.lastname: Scherer
authors.forename: Jan
authors.initials: J
authors.lastname: Schmidt
authors.forename: Stephan
authors.initials: S
authors.lastname: Macher-Goeppinger
authors.forename: Katrin
authors.initials: K
authors.lastname: Klein
authors.forename: Claudia
authors.initials: C
authors.lastname: Sommerer
authors.forename: Vedat
authors.initials: V
authors.lastname: Schwenger
authors.forename: Martin
authors.initials: M
authors.lastname: Zeier
authors.forename: Caner
authors.initials: C
authors.lastname: Süsal
mesh_terms: D000328:Adult; D000465:Algorithms; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D001781:Blood Component Removal / Q000379:methods; D003888:Desensitization, Immunologic / Q000379:methods; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis; D006085:Graft Survival; D006650:Histocompatibility Testing; D006801:Humans; D007163:Immunosorbent Techniques; D007165:Immunosuppression Therapy / Q000379:methods; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology* / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D000069283:Rituximab; D016896:Treatment Outcome
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab