Successful kidney transplantation in highly sensitized patients
Received date: 09 Dec 2010
Accepted date: 13 Jan 2011
Published date: 05 Mar 2011
Copyright
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 panel-reactive 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.
Key words: Kidney transplantation; desensitization
Weijie ZHANG , Dong CHEN , Zhishui CHEN , Fanjun ZENG , Changsheng MING , Zhengbin LIN , Ping ZHOU , Gang CHEN , Xiaoping CHEN . Successful kidney transplantation in highly sensitized patients[J]. Frontiers of Medicine, 2011 , 5(1) : 80 -85 . DOI: 10.1007/s11684-011-0115-0
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