Successful kidney transplantation in highly sensitized patients

Abstract

Highly sensitized patients experience an increased number of rejection episodes and have poorer graft survival rates; hence, sensitization is a significant barrier to both access to and the success of organ transplantation. This study reports our experience in kidney transplantation in highly sensitized patients. Fourteen patients with sensitization or high levels of panelreactive antibodies (PRA) were studied. All patients were desensitized with pre-transplant intravenous immunoglobulin (IVIG)/plasmapheresis (PP) with or without rituximab and thymoglobulin induction therapy, combined with a Prograf/MMF/Pred immunosuppressive regimen. Of 14 patients, 10 showed good graft functions without acute rejection (AR) episodes. Acute cellular rejection in two patients was reversed by methylprednisolone. Two patients underwent antibody-mediated rejection; one was treated with PP/IVIG successfully, whereas the other lost graft functions due to the de novo production of donor-specific antibodies (DSA). Graft functions were stable, and there were no AR episodes in other patients. Conclusively, desensitization using PP/IVIG with or without rituximab increases the likelihood of successful live-donor kidney transplantation in sensitized recipients.

Infectious Complications in Living-Donor Kidney Transplant Recipients Undergoing Multi-Modal Desensitization

“…In addition, the regimen used for desensitization and described above resulted in excellent patient and graft survival, which were comparable to previously reported results [8][9][10]. Episodes of organ rejection episodes were significantly more frequent in the DS patients in the first year after transplantation, which was an expected finding in light of the DS patients' allosensitization before transplantation.…”

“…Episodes of organ rejection episodes were significantly more frequent in the DS patients in the first year after transplantation, which was an expected finding in light of the DS patients' allosensitization before transplantation. Other investigators have reported rates of rejection of 24.1% [9] to 28.6% [10] for LDK transplantation. Although rejection was more common in the DS patients in our study, cumulative graft loss was not.…”

Dialysis Access and Preemptive Kidney Transplantation

“…The desensitization protocol varies at each transplant center, and several desensitization protocols have been used to prevent AMR. These protocols have increased the success rate in sensitized recipients [41,43,44]. The common desensitization protocol includes pretransplant apheresis, induction therapy with anti-CD20 antibody and intravenous immunoglobulin, and maintenance therapy with immunosuppressive drugs [45][46][47][48].…”

Rabbit antithymocyte globulin induces human lymphocyte activation, proliferation, and apoptosis in the absence of complement: an experimental study

“…rATG is advantageous in preventing acute rejection among transplant recipients at high risk [6], especially in human lymphocyte antigen (HLA)-presensitized patients [7]. Therefore, it is the first choice for induction therapy in HLA-presensitized patients undergoing organ transplantation [8,9].…”