Preventing sensitization with mycophenolate mofetil in a pediatric kidney recipient

Abstract

Sensitization, as measured by panel reactive antibodies (PRAs), occurs as a result of previous organ transplantation, blood transfusions, or pregnancy. The high-PRA levels increase the risk of complications during transplantation and may result in long time duration for future transplants. Mycophenolate mofetil (MMF) has been shown to decrease lymphocyte proliferation and antibody formation. We report the use of prophylactic MMF in preventing the formation of PRAs in a pediatric renal transplant recipient with multiple donor exposures. A four-yr-old girl received an unsuccessful living-related renal transplant in February 2003 and was subject to multiple blood transfusions in the perioperative period. MMF, 500 mg/m2/day in two divided doses, achieved suppression of PRAs to less than 20% and allowed successful renal transplantation within nine months. No side effects occurred. This approach may reduce the risk of sensitization in future potential organ donor recipients in similar situations.

Donor human leukocyte antigen specific antibodies predict development and define prognosis in transplant glomerulopathy

“…Previous studies showed that mycophenolate mofetil (MMF) therapy reduces humoral immune response and has been used as a component of rescue therapy for grafts suffering antibody-mediated injury [16,17]. Other studies reported the use of MMF to prevent sensitization in transplantation, and removal of MMF may be associated with late antibody-mediated rejection [18,19]. In this study, there was no observed protective effect of MMF on TG development.…”

Favorable four‐yr outcome after renal transplantation in a patient with complement factor H antibody and CFHR1/CFHR3 gene mutation‐associated HUS

“…Khandelwal et al have described different protocols in CFH antibodyrelated primary aHUS in children, in whom (in combination with PF) they used IV cyclophosphamide (n = 31) or rituximab (n = 14), and maintenance immunosuppression was based on MMF (n = 24), prednisolone (n = 16), and azathioprine plus prednisolone (n = 5), with no significant difference between these protocols in terms of efficacy (expressed as relapse-free follow-up) (11). The rationale to use MMF in our case (to block antibody production) was based on the experience with this drug in inhibiting proliferation of T and B cells, blocking primary antibody response and PRA production in children undergoing multiple renal transplantation or open heart surgery with placing valved allografts (12,13). The optimal dose and trough MPA concentration in this term are not pre- cisely defined.…”

Panel-reactive antibody levels and renal transplantation rates in sensitized patients after desensitization and human leucocyte antigen amino acid residue matching

“…MMF has been shown to reduce the HLA alloimmune antibody response to valved allograft implantation and to achieve suppression of PRA to <20%. 19,20 A study involving 154 transplant recipients showed that MMF reduced anti-HLA class I and II antibody production after renal transplantation. 21 Plasmapheresis can be used to decrease HLA antibodies in the pretransplant period, which may allow transplantation to occur.…”