J Korean Med Sci.  2009 Jan;24(Suppl 1):S143-S147. 10.3346/jkms.2009.24.S1.S143.

Kidney Transplantation in Sensitized Recipients; A Single Center Experience

• Kim SM
• Lee C
• Lee JP
• Kim EM
• Ha J
• Kim SJ
• Park MH
• Ahn C
• Kim YS

• KMID: 1778154
• DOI: http://doi.org/10.3346/jkms.2009.24.S1.S143

Abstract

A successful transplantation, across a positive crossmatch barrier, is one of the most persistent long- standing problems in the field of kidney transplant medicine. The aim of this study was to describe seven consecutive living renal transplantations in recipients with positive crossmatch for donors or positive for donor specific antibodies (DSAs). A preconditioning regimen including plasmapheresis and intravenous immunoglobulin was delivered three times a week until the crossmatch and/ or DSAs became negative. Mycophenolate mofetil and tacrolimus were started two days before the plasmapheresis. The protocol was modified to include administration of anti-CD 20 antibody (rituximab, 375 mg/m(2)) from the patient number 3 through the patient number 7. All seven patients achieved negative conversion of the crossmatch or DSAs, and the kidney transplantations were successfully performed in all cases. Acute cellular rejection occurred in two patients, which were subclinical and controlled with high dose steroid treatment. Antibody-mediated rejection occurred in one patient, which was easily reversed with plasmapheresis. All recipients attained normal graft function during the 7-24 months of follow up. Our study suggests that sensitized patients can be transplanted successfully with desensitization pretreatment.

Keyword

Desensitization, Immunologic; Immunoglobulins, Intravenous; Kidney Transplantation; Plasmapheresis; Rituximab

MeSH Terms

Adult
Antibodies, Monoclonal/pharmacology
Antigens, CD20/biosynthesis
Biopsy
Female
Graft Rejection
Graft Survival
Histocompatibility Testing/methods
Humans
Immunoglobulins/chemistry
Kidney Transplantation/*methods
Male
Middle Aged
Plasmapheresis
Transplantation Conditioning

Figure

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  Fig. 1 Desensitization protocol. Anti-CD 20 Ab, anti-CD 20 antibody; PP, plasmapheresis; IVIG, intravenous immunoglobulin; DSA, donor specific antibody; OP, operation.

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