title: Mesenchymal stem cell transfusion for desensitization of positive lymphocyte cross-match before kidney transplantation: outcome of 3 cases.
abstract: OBJECTIVE
  Donor specific antibodies (DSA) and a positive cross-match are contraindications for kidney transplantation. Trials of allograft transplantation across the HLA barrier have employed desensitization strategies, including the use of plasmapheresis, intravenous immunoglobulins, anti-B-cell monoclonal antibodies and splenectomy, associated with high-intensity immunosuppressive regimens. Our case 1 report suffered from repeatedly positive lymphocyte cross match after 1st renal transplantation. Graft nephrectomy could not correct the state of sensitization. Splenectomy was done in a trial to get rid of the antibody producing clone. Furthermore plasmapheresis with low dose IVIG could not as well revert the state of sensitization for the patient.
  
  
  METHODS
  About 50 millions donor specific MSCs were injected to the patient.
  
  
  RESULTS
  MSCs transfusion proved to be the only procedure which could achieve successful desensitization before performing the second transplantation owing to their immunosuppressive properties.
  
  
  CONCLUSIONS
  This case indicates that DS-MSCs is a potential option for anti-HLA desensitization. In cases 2 and 3 IV DS-MSCs transfusion was selected from the start as a successful line of treatment for pre renal transplantation desensitization to save other unnecessary lines of treatment that were tried in case 1.
authors.affiliation: Department of Internal Medicine and Nephrology, Cairo University, Cairo, Egypt.
authors.forename: G
authors.initials: G
authors.lastname: Saadi
authors.forename: F
authors.initials: F
authors.lastname: Fadel
authors.forename: M
authors.initials: M
authors.lastname: El Ansary
authors.forename: S Abd
authors.initials: SA
authors.lastname: El-Hamid
mesh_terms: D000328:Adult; D000918:Antibody Specificity; D002648:Child; D003888:Desensitization, Immunologic / Q000379:methods*; D005260:Female; D006680:HLA Antigens / Q000276:immunology; D006648:Histocompatibility; D006650:Histocompatibility Testing; D006801:Humans; D016756:Immunoglobulins, Intravenous; D007165:Immunosuppression Therapy; D007518:Isoantibodies / Q000276:immunology; D007668:Kidney / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000276:immunology / Q000628:therapy*; D016030:Kidney Transplantation / Q000276:immunology* / Q000379:methods; D008214:Lymphocytes / Q000276:immunology*; D008297:Male; D045164:Mesenchymal Stem Cell Transplantation / Q000379:methods*; D059630:Mesenchymal Stem Cells / Q000276:immunology; D008875:Middle Aged; D010956:Plasmapheresis / Q000379:methods; D012307:Risk Factors; D013156:Splenectomy; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D006680:HLA Antigens; D016756:Immunoglobulins, Intravenous; D007518:Isoantibodies