title: Desensitization Protocol in Recipients of Deceased Kidney Donor With Donor-Specific Antibody-Low Titers.
abstract: BACKGROUND
  Kidney transplantation is the better option for end-stage renal disease (ESRD), but for patients with human leukocyte antigen (HLA) sensitization, the wait times are significantly longer than for patients without antibodies. Many desensitization protocols have been described involving strong immunosuppression, the use of apheresis, and B-cell-modulating therapies. We have designed a desensitization protocol from day 0 for deceased donor kidney transplantation. Our aim was to present our initial experience with five kidney transplant patients.
  
  
  METHODS
  All patients had a negative complement-dependent cytotoxicity cross-match. The desensitization protocol included five to seven doses of thymoglobulin (1.25 mg/kg) and three sessions of plasmapheresis (PP) within the first week after transplantation, with intravenous immunoglobulin (500 mg/kg) after each PP session and one dose of rituximab on day 8. The presence of donor-specific antibodies (DSA) was analyzed by use of Luminex technology; levels between 1000 and 3000 mean fluorescence intensity were considered for desensitization.
  
  
  RESULTS
  The median age was 44 years and median renal replacement therapy time was 9 years. All recipients presented 1 to 3 DSA specificities. There were no severe side effects related to PP, infusion of intravenous immunoglobulin, or rituximab. The median follow-up period was 19.3 months. Median serum creatinine level at last follow-up was 1.7 mg/dL. A kidney biopsy was performed in all patients. Graft and patient survival was 100%.
  
  
  CONCLUSIONS
  Until now, few data are available concerning whether HLA-incompatible kidney transplantation after desensitization would benefit patients with ERSD. The desensitization strategy using the combination of PP, low doses of intravenous immunoglobulin, and rituximab at our center resulted in a satisfactory clinical outcome.
authors.affiliation: Nephrology Department, Hospital Dr Peset, Valencia, Spain. Electronic address: julikanter@gmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Kanter Berga
authors.affiliation: Nephrology Department, Hospital Dr Peset, Valencia, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Sancho Calabuig
authors.affiliation: Nephrology Department, Hospital Dr Peset, Valencia, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Gavela Martinez
authors.affiliation: HLA Department, Centro de transfusiones de la Comunidad Valenciana, Valencia, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Puig Alcaraz
authors.affiliation: Nephrology Department, Hospital Dr Peset, Valencia, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Avila Bernabeu
authors.affiliation: Nephrology Department, Hospital Dr Peset, Valencia, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Crespo Albiach
authors.affiliation: Nephrology Department, Hospital Dr Peset, Valencia, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Molina Vila
authors.affiliation: Nephrology Department, Hospital Dr Peset, Valencia, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Beltrán Catalan
authors.affiliation: Nephrology Department, Hospital Dr Peset, Valencia, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Pallardó Mateu
mesh_terms: D000328:Adult; D000906:Antibodies / Q000032:analysis / Q000276:immunology*; D000961:Antilymphocyte Serum / Q000008:administration & dosage; D003888:Desensitization, Immunologic / Q000379:methods*; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects; D006680:HLA Antigens / Q000032:analysis / Q000276:immunology*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage; D007155:Immunologic Factors / Q000008:administration & dosage; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007668:Kidney / Q000187:drug effects / Q000276:immunology / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D000069283:Rituximab / Q000008:administration & dosage
chemical_list: D000906:Antibodies; D000961:Antilymphocyte Serum; D006680:HLA Antigens; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D000069283:Rituximab; C512542:thymoglobulin