title: Six-year outcomes in broadly HLA-sensitized living donor transplant recipients desensitized with intravenous immunoglobulin and rituximab.
abstract: Desensitization with intravenous immunoglobulin (IVIG) and rituximab can improve transplantation rates in broadly sensitized kidney transplant recipients. However, long-term outcomes are lacking. Here we analyze long-term outcomes in living donor kidney transplant recipients desensitized with this regimen and compare them to low-risk recipients. Living donor kidney transplants that took place between July 2006 and December 2010 were considered retrospectively. The primary end point of the study was death-censored allograft survival at last follow-up. Secondary end points included patient survival, incidence of rejection, glomerular filtration rate (GFR), and proteinuria. There were 66 sensitized and 111 low-risk patients included. Average follow-up was 68 months. There was no difference in long-term patient or graft survival. The rate of rejection was similar in the groups with more early rejection in the sensitized group and more late rejection in the low-risk group. There was more antibody-mediated rejection in the sensitized group. Estimated GFR was similar during the follow-up period. Risk factors for rejection included a positive cross-match (HR: 2.4 CI: 1.35-4.40) and age (HR: 0.97 CI: 0.95-0.99). Desensitization with IVIG and rituximab has good long-term results with graft outcomes similar to non-HLA-sensitized patients despite higher immunologic risk.
authors.affiliation: Cedars-Sinai Medical Center, Comprehensive Transplant Center, Los Angeles, CA, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Kahwaji
authors.affiliation: Cedars-Sinai Medical Center, Comprehensive Transplant Center, Los Angeles, CA, USA.
authors.forename: Stanley C
authors.initials: SC
authors.lastname: Jordan
authors.affiliation: Cedars-Sinai Medical Center, Comprehensive Transplant Center, Los Angeles, CA, USA.
authors.forename: Reiad
authors.initials: R
authors.lastname: Najjar
authors.affiliation: Cedars-Sinai Medical Center, Comprehensive Transplant Center, Los Angeles, CA, USA.
authors.forename: Patarapha
authors.initials: P
authors.lastname: Wongsaroj
authors.affiliation: Cedars-Sinai Medical Center, Comprehensive Transplant Center, Los Angeles, CA, USA.
authors.forename: Jua
authors.initials: J
authors.lastname: Choi
authors.affiliation: Cedars-Sinai Medical Center, Comprehensive Transplant Center, Los Angeles, CA, USA.
authors.forename: Alice
authors.initials: A
authors.lastname: Peng
authors.affiliation: Cedars-Sinai Medical Center, Comprehensive Transplant Center, Los Angeles, CA, USA.
authors.forename: Rafael
authors.initials: R
authors.lastname: Villicana
authors.affiliation: Cedars-Sinai Medical Center, Comprehensive Transplant Center, Los Angeles, CA, USA.
authors.forename: Ashley
authors.initials: A
authors.lastname: Vo
mesh_terms: D000328:Adult; D003888:Desensitization, Immunologic; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection; D006085:Graft Survival; D006680:HLA Antigens / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000276:immunology; D012189:Retrospective Studies; D012307:Risk Factors; D000069283:Rituximab / Q000627:therapeutic use*; D066027:Transplant Recipients; D016896:Treatment Outcome
chemical_list: D006680:HLA Antigens; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D000069283:Rituximab
keywords: 
  ABMR
  ; desensitization; donor-specific antibodies; plasma exchange; transplant glomerulopathy