title: Outcome after Desensitization in HLA or ABO-Incompatible Kidney Transplant Recipients: A Single Center Experience.
abstract: BACKGROUND
  The shortage of deceased donors led to an increase of living donor kidney (LDK) transplantations performed in the presence of donor-specific antibodies (DSA) or ABO incompatibility (ABOi) using various desensitization protocols.
  
  
  METHODS
  We herein analyzed 26 ABOi and 8 Luminex positive DSA patients who were successfully desensitized by anti-CD20, antigen-specific immunoadsorption and/or plasmapheresis to receive an LDK transplant. Twenty LDK recipients with non-donor-specific HLA-antibodies (low risk) and 32 without anti-HLA antibodies (no risk) served as control groups.
  
  
  RESULTS
  1-year graft survival rate and renal function was similar in all 4 groups (creatinine: 1.63 ± 0.5 vs 1.78 ± 0.6 vs 1.64 ± 0.5 vs 1.6 ± 0.3 mg/dl in ABOi, DSA, low risk and no risk group). The incidence of acute T-cell mediated rejections did not differ between the 4 groups (15% vs 12, 5% vs 15% vs 22% in ABOi, DSA, low risk and no risk), while antibody-mediated rejections were only found in the DSA (25%) and ABOi (7.5%) groups. Incidence of BK nephropathy (BKVN) was significantly more frequent after desensitization as compared to controls (5/34 vs 0/52, p = 0.03).
  
  
  CONCLUSIONS
  We demonstrate favorable short-term allograft outcome in LDK transplant recipients after desensitization. However, the desensitization was associated with an increased risk of BKVN.
authors.affiliation: Laboratory for Immunogenetics, University Hospital LMU, Munich, Germany.|Clinic for General, Visceral-, Transplantation-, Vascular- and Thoracic Surgery, University Hospital LMU, Munich, Germany.
authors.forename: Teresa
authors.initials: T
authors.lastname: Kauke
authors.affiliation: Transplant Center, University Hospital LMU, Munich, Germany.
authors.forename: Sandra
authors.initials: S
authors.lastname: Klimaschewski
authors.affiliation: Department of Internal Medicine IV, Renal Division, University Hospital LMU, Munich, Germany.
authors.forename: Ulf
authors.initials: U
authors.lastname: Schoenermarck
authors.affiliation: Department of Internal Medicine IV, Renal Division, University Hospital LMU, Munich, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Fischereder
authors.affiliation: Laboratory for Immunogenetics, University Hospital LMU, Munich, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Dick
authors.affiliation: Clinic for General, Visceral-, Transplantation-, Vascular- and Thoracic Surgery, University Hospital LMU, Munich, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Guba
authors.affiliation: Clinic for General, Visceral-, Transplantation-, Vascular- and Thoracic Surgery, University Hospital LMU, Munich, Germany.
authors.forename: Manfred
authors.initials: M
authors.lastname: Stangl
authors.affiliation: Clinic for General, Visceral-, Transplantation-, Vascular- and Thoracic Surgery, University Hospital LMU, Munich, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Werner
authors.affiliation: Transplant Center, University Hospital LMU, Munich, Germany.
authors.forename: Bruno
authors.initials: B
authors.lastname: Meiser
authors.affiliation: Transplant Center, University Hospital LMU, Munich, Germany.
authors.forename: Antje
authors.initials: A
authors.lastname: Habicht
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000328:Adult; D001739:BK Virus / Q000276:immunology / Q000302:isolation & purification; D001787:Blood Group Incompatibility / Q000150:complications / Q000276:immunology*; D003888:Desensitization, Immunologic / Q000009:adverse effects / Q000379:methods; D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000276:immunology; D006085:Graft Survival; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D007668:Kidney / Q000276:immunology / Q000821:virology; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D027601:Polyomavirus Infections / Q000209:etiology / Q000276:immunology; D012189:Retrospective Studies; D066027:Transplant Recipients
chemical_list: D000017:ABO Blood-Group System; D006680:HLA Antigens