Desensitization in HLA-Incompatible Kidney Recipients and Survival

Abstract

Live-donor transplantation after desensitization provided a significant survival benefit for patients with HLA sensitization, as compared with waiting for a compatible organ. By 8 years, this survival advantage more than doubled. These data provide evidence that desensitization protocols may help overcome incompatibility barriers in live-donor renal transplantation. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and the Charles T. Bauer Foundation.).

Safety, immunogenicity, pharmacokinetics, and efficacy of degradation of anti-HLA antibodies by IdeS (imlifidase) in chronic kidney disease patients

“…In the past, the detection of donor‐specific antibodies (DSAs) pretransplant was considered a contraindication to transplant. However, because the number of highly sensitized patients on the transplant waiting lists has increased, desensitizing strategies have been developed to allow such patients to benefit from transplant with a kidney from a living HLA‐incompatible donor 2, 3, 4. These strategies use preconditioning with cycles of high‐dose intravenous Ig (IVIg), or plasmapheresis combined with low‐dose IVIg,5 but can include other agents such as rituximab 6, 7.…”

“…Desensitization has increased transplant rates, reduced waiting times, and provided a significant survival benefit for patients with DSA compared with waiting for an HLA‐compatible transplant 8. Transplant of an HLA‐incompatible kidney after desensitization is, however, associated with an increased risk of ABMR, in both the short and longer term 4, 9…”

Eculizumab Prevents Recurrent Antiphospholipid Antibody Syndrome and Enables Successful Renal Transplantation

“…In renal transplant recipients, it has been used for the treatment of a variety of complement/ antibody-mediated microangiopathy syndromes including aHUS (24,25) and antibody-mediated rejection (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) and in single case studies of patients with CAPS (13) and APS (27).…”

“…Immunosuppression, plasmapheresis, cytomegalovirus immune globulin (CMVIg; 100 mg/kg) and monitoring of DSA were performed as previously described (11). Patient 2 received 4 pre-and 19 posttransplant plasmapheresis treatments, and patient 3 received 2 pre-and 7 posttransplant.…”

The Other Half of Informed Consent

“…If the person providing the education were not informed about this change, HIV-positive patients might simply be told they were ineligible and never seek or attain access. Similarly, over the past decade, there have been major advances in KT for pediatric patients (14), those aged .65 years (15), obese patients (7,16), and patients with donors incompatible by HLA or blood type, both by desensitization (17,18) and kidney exchange (19). In addition, much more is known today about the incremental risks of live donation (20)(21)(22).…”