title: Kidney Transplantation Results in Very Highly Sensitized Patients Included in a Virtual Crossmatch Program: Analysis of Kidney Pairs.
abstract: BACKGROUND
  Kidney transplantation in highly-sensitized (HS) patients can improve with organ-exchange strategies based on virtual crossmatch (V-XM). Experience in very-HS patients is limited.
  
  
  METHODS
  In June 2012, Andalusia started a V-XM protocol for very-HS patients (calculated panel reactive antibodies ≥95%). After organ allocation a cytotoxic-XM performed immediately before transplantation had to be negative for surgery to proceed. We analyzed results up until December 2015. Whenever possible we also compared the course of the recipient (non-HS) of the other kidney from the same donor.
  
  
  RESULTS
  Of the 57 grafts, 52 kidney transplantations were performed (the pretransplantation cytotoxic-XM was positive in 5; predictive value 91.3%). Five patients (9.6%) experienced acute rejection (4 antibody-mediated rejections [AMRs]; 7.6%). Donor-specific antibodies developed in 10 patients. No patient died. One-year graft survival was 98%. We compared the course of the non-HS recipient of the other kidney, excluding cases with no pair (n = 5), pairs who were children recipients (n = 3), pancreas-kidney recipients (n = 5), or pairs already included in the V-XM protocol (n = 4). Finally, 35 pairs were studied. More HS-patients developed donor-specific antibodies (P = .016). No significant differences were seen in acute rejection, but AMR was more common (P = .057). No deaths occurred in either group, and there were no differences in graft survival or renal function.
  
  
  CONCLUSIONS
  Although a few patients still developed AMR, our V-XM based protocol with a final pretransplantation cytotoxic-XM achieved very satisfactory results. Although the number of patients was limited, the initial survival of these high-risk recipients was comparable to the controls.
authors.affiliation: Nephrology Department, Hospital Puerta del Mar, Cadiz, Spain. Electronic address: mauxiliadora.mazuecos.sspa@juntadeandalucia.es.
authors.forename: A
authors.initials: A
authors.lastname: Mazuecos
authors.affiliation: Coordinacion de Trasplantes de Andalucia, Sevilla, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Alvarez
authors.affiliation: Immunology Department, Hospital Puerta del Mar, Cadiz, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Nieto
authors.affiliation: Nephrology Department, Hospital Virgen del Rocio, Sevilla, Spain.
authors.forename: M A
authors.initials: MA
authors.lastname: Gentil
authors.affiliation: Nephrology Department, Hospital Regional de Malaga, Malaga, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Cabello
authors.affiliation: Nephrology Department, Hospital Reina Sofia, Cordoba, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Rodriguez-Benot
authors.affiliation: Nephrology Department, Hospital Virgen de las Nieves, Granada, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Gracia
authors.affiliation: Immunology Department, Hospital Virgen del Rocio, Sevilla, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Gonzalez
authors.affiliation: Coordinacion de Trasplantes de Andalucia, Sevilla, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Castro
authors.affiliation: Coordinacion de Trasplantes de Andalucia, Sevilla, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Alonso
mesh_terms: D000328:Adult; D000906:Antibodies / Q000276:immunology; D001788:Blood Grouping and Crossmatching / Q000379:methods*; D016022:Case-Control Studies; D002985:Clinical Protocols; D005260:Female; D006084:Graft Rejection / Q000276:immunology; D006085:Graft Survival / Q000276:immunology*; D006680:HLA Antigens / Q000276:immunology; D006801:Humans; D007674:Kidney Diseases / Q000601:surgery; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000706:statistics & numerical data; D014019:Tissue Donors / Q000706:statistics & numerical data
chemical_list: D000906:Antibodies; D006680:HLA Antigens