title: Kidney paired donation in the presence of donor-specific antibodies.
abstract: Incompatible donor/recipient pairs with broadly sensitized recipients have difficulty finding a crossmatch-compatible match, despite a large kidney paired donation pool. One approach to this problem is to combine kidney paired donation with lower-risk crossmatch-incompatible transplantation with intravenous immunoglobulin. Whether this strategy is non-inferior compared with transplantation of sensitized patients without donor-specific antibody (DSA) is unknown. Here we used a protocol including a virtual crossmatch to identify acceptable crossmatch-incompatible donors and the administration of intravenous immunoglobulin to transplant 12 HLA-sensitized patients (median calculated panel reactive antibody 98%) with allografts from our kidney paired donation program. This group constituted the DSA(+) kidney paired donation group. We compared rates of rejection and survival between the DSA(+) kidney paired donation group with a similar group of 10 highly sensitized patients (median calculated panel reactive antibody 85%) that underwent DSA(-) kidney paired donation transplantation without intravenous immunoglobulin. At median follow-up of 22 months, the DSA(+) kidney paired donation group had patient and graft survival of 100%. Three patients in the DSA(+) kidney paired donation group experienced antibody-mediated rejection. Patient and graft survival in the DSA(-) kidney paired donation recipients was 100% at median follow-up of 18 months. No rejection occurred in the DSA(-) kidney paired donation group. Thus, our study provides a clinical framework through which kidney paired donation can be performed with acceptable outcomes across a crossmatch-incompatible transplant.
authors.affiliation: Department of Urology, Kidney Transplant Program, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Blumberg
authors.forename: Hans A
authors.initials: HA
authors.lastname: Gritsch
authors.forename: Elaine F
authors.initials: EF
authors.lastname: Reed
authors.forename: J M
authors.initials: JM
authors.lastname: Cecka
authors.forename: Gerald S
authors.initials: GS
authors.lastname: Lipshutz
authors.forename: Gabriel M
authors.initials: GM
authors.lastname: Danovitch
authors.forename: Suzanne
authors.initials: S
authors.lastname: McGuire
authors.forename: David W
authors.initials: DW
authors.lastname: Gjertson
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Veale
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006084:Graft Rejection / Q000276:immunology* / Q000401:mortality / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects*; D006680:HLA Antigens / Q000276:immunology*; D006648:Histocompatibility; D006650:Histocompatibility Testing; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007518:Isoantibodies / Q000097:blood*; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists
chemical_list: D006680:HLA Antigens; D016756:Immunoglobulins, Intravenous; D007518:Isoantibodies