title: Kidney transplantation across a positive crossmatch: a single-center experience.
abstract: BACKGROUND
  Kidney transplantation is the treatment of choice for end-stage renal disease, with improved mortality and quality of life compared with dialysis. Desensitization protocols have allowed kidney transplantation of highly sensitized patients, who have a lower probability to receive a matching kidney from a deceased or living donor. The aim of this work was to analyze the post-transplantation period of highly HLA-sensitized patients with positive flow cytometry crossmatch against donor cells.
  
  
  METHODS
  Following an observational, retrospective design, we investigated 16 highly sensitized patients who underwent kidney or kidney-pancreas transplantation, assessing the impact of desensitization protocols and investigating treatment-related complications, graft function, antibody-mediated rejection (AMR) rate, and graft and patient survivals.
  
  
  RESULTS
  We studied 16 patients with positive flow cytometry crossmatch, who were divided into 2 groups based on whether they were submitted to a desensitization protocol or not. Patients who were desensitized underwent transplantation in later years, had higher immunologic risk (panel reactive antibody peak 62% vs 33%; P = .038), higher percentage of 2nd kidney transplant (75% vs 25%; P = .066), and higher percentage of donor-specific anti-HLA antibodies identified (P = .028). A majority of patients were desensitized with high-dose intravenous immunoglobulin and plasmapheresis, and 5 patients received rituximab. Acute AMR rate was of 38%, and rituximab was associated with fewer episodes of AMR. Only 1 patient had graft failure, due to chronic humoral rejection, and the remaining maintained good graft function (mean serum creatinine value of 1.33 mg/dL). No patient died and few complications related to immunossupression were observed.
  
  
  CONCLUSIONS
  Desensitization protocols were safe and allowed kidney transplantation in highly sensitized patients that probably would never undergo transplantation and gave the opportunity of living-donor transplant to patients with anti-HLA antibodies against the donor.
authors.affiliation: Nephrology Department, Hospital Santo António, Centro Hospitalar Porto, Porto, Portugal. Electronic address: mclaracsantos@gmail.com.
authors.forename: C
authors.initials: C
authors.lastname: Santos
authors.affiliation: Nephrology Department, Hospital Santo António, Centro Hospitalar Porto, Porto, Portugal.
authors.forename: R
authors.initials: R
authors.lastname: Costa
authors.affiliation: Nephrology Department, Hospital Santo António, Centro Hospitalar Porto, Porto, Portugal.
authors.forename: J
authors.initials: J
authors.lastname: Malheiro
authors.affiliation: Nephrology Department, Hospital Santo António, Centro Hospitalar Porto, Porto, Portugal.
authors.forename: S
authors.initials: S
authors.lastname: Pedroso
authors.affiliation: Nephrology Department, Hospital Santo António, Centro Hospitalar Porto, Porto, Portugal.
authors.forename: M
authors.initials: M
authors.lastname: Almeida
authors.affiliation: Nephrology Department, Hospital Santo António, Centro Hospitalar Porto, Porto, Portugal.
authors.forename: L S
authors.initials: LS
authors.lastname: Martins
authors.affiliation: Nephrology Department, Hospital Santo António, Centro Hospitalar Porto, Porto, Portugal.
authors.forename: L
authors.initials: L
authors.lastname: Dias
authors.affiliation: Centro Histocompatibilidade Norte, Porto, Portugal.
authors.forename: S
authors.initials: S
authors.lastname: Tafulo
authors.affiliation: Nephrology Department, Hospital Santo António, Centro Hospitalar Porto, Porto, Portugal.
authors.forename: A C
authors.initials: AC
authors.lastname: Henriques
authors.affiliation: Nephrology Department, Hospital Santo António, Centro Hospitalar Porto, Porto, Portugal.
authors.forename: A
authors.initials: A
authors.lastname: Cabrita
mesh_terms: D000328:Adult; D000906:Antibodies / Q000097:blood; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D003888:Desensitization, Immunologic; D005260:Female; D005434:Flow Cytometry; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control*; D006680:HLA Antigens / Q000276:immunology; D006650:Histocompatibility Testing; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use; D016030:Kidney Transplantation; D008297:Male; D010956:Plasmapheresis; D012086:Reoperation; D012189:Retrospective Studies; D000069283:Rituximab
chemical_list: D000906:Antibodies; D058846:Antibodies, Monoclonal, Murine-Derived; D006680:HLA Antigens; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D000069283:Rituximab