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
| 1 |
Vasilescu E R, Ho E K, Colovai A I, Vlad G, Foca-Rodi A, Markowitz G S, D’Agati V, Hardy M A, Ratner L E, Suciu-Foca N. Alloantibodies and the outcome of cadaver kidney allografts. Hum Immunol, 2006, 67(8): 597-604
|
| 2 |
Gebel H M, Moussa O, Eckels D D, Bray R A. Donor-reactive HLA antibodies in renal allograft recipients: considerations, complications, and conundrums. Hum Immunol, 2009, 70(8): 610-617
|
| 3 |
Flores-Gama F, Mondragón-Ramírez G A, Bochicchio-Riccardelli T. Desensitization and renal transplant: plasmapheresis/IVIG standard dose in patients with high immunological risk. Cir Cir, 2009, 77(5): 369-374
|
| 4 |
Varma P P, Hooda A K, Kumar A, Singh L. Highly successful and low-cost desensitization regime for sensitized living donor renal transplant recipients. Ren Fail, 2009, 31(7): 533-537
|
| 5 |
Kim S M, Lee C, Lee J P, Kim E M, Ha J, Kim S J, Park M H, Ahn C, Kim Y S. Kidney transplantation in sensitized recipients; a single center experience. J Korean Med Sci, 2009, 24 (Suppl): S143-S147
|
| 6 |
Faenza A, Fuga G, Bertelli R, Scolari M P, Buscaroli A, Stefoni S. Hyperimmunized patients awaiting cadaveric kidney graft: is there a quick desensitization possible? Transplant Proc, 2008, 40(6): 1833-1838
|
| 7 |
Segev D L, Gentry S E, Melancon J K, Montgomery R A. Characterization of waiting times in a simulation of kidney paired donation. Am J Transplant, 2005, 5(10): 2448-2455
|
| 8 |
Claas F H, Doxiadis I I. Management of the highly sensitized patient. Curr Opin Immunol, 2009, 21(5): 569-572
|
| 9 |
Yoon H E, Hyoung B J, Hwang H S, Lee S Y, Jeon Y J, Song J C, Oh E J, Park S C, Choi B S, Moon I S, Kim Y S, Yang C W. Successful renal transplantation with desensitization in highly sensitized patients: a single center experience. J Korean Med Sci, 2009, 24 (Suppl): S148-S155
|
| 10 |
Fourtounas C, Mouzaki A, Vlachojannis J G. Desensitization during renal transplantation. N Engl J Med, 2008; 359: 1731-1732
|
| 11 |
Jordan S C, Vo A, Tyan D, Toyota M. Desensitization therapy with intravenous gammaglobulin (IVIG): applications in solid organ transplantation. Trans Am Clin Climatol Assoc, 2006, 117: 199-211, discussion 211
|
| 12 |
Jordan S. IVIG vs. plasmapheresis for desensitization: which is better? Am J Transplant, 2006, 6(7): 1510-1511
|
| 13 |
Glotz D, Antoine C, Julia P, Suberbielle-Boissel C, Boudjeltia S, Fraoui R, Hacen C, Duboust A, Bariety J. Desensitization and subsequent kidney transplantation of patients using intravenous immunoglobulins (IVIg). Am J Transplant, 2002, 2(8): 758-760
|
| 14 |
Akalin E, Dinavahi R, Friedlander R, Ames S, de Boccardo G, Sehgal V, Schröppel B, Bhaskaran M, Lerner S, Fotino M, Murphy B, Bromberg J S. Addition of plasmapheresis decreases the incidence of acute antibody-mediated rejection in sensitized patients with strong donor-specific antibodies. Clin J Am Soc Nephrol, 2008, 3(4): 1160-1167
|
| 15 |
Stegall M D, Gloor J, Winters J L, Moore S B, Degoey S. A comparison of plasmapheresis versus high-dose IVIG desensitization in renal allograft recipients with high levels of donor specific alloantibody. Am J Transplant, 2006, 6(2): 346-351
|
| 16 |
Vo A A, Lukovsky M, Toyoda M, Wang J, Reinsmoen N L, Lai C H, Peng A, Villicana R, Jordan S C. Rituximab and intravenous immune globulin for desensitization during renal transplantation. N Engl J Med, 2008, 359(3): 242-251
|
| 17 |
Munoz A S, Rioveros A A, Cabanayan-Casasola C B, Danguilan R A, Ona E T. Rituximab in highly sensitized kidney transplant recipients. Transplant Proc, 2008, 40(7): 2218-2221
|
| 18 |
Buehrig C K, Lager D J, Stegall M D, Kreps M A, Kremers W K, Gloor J M, Schwab T R, Velosa J A, Fidler M E, Larson T S, Griffin M D. Influence of surveillance renal allograft biopsy on diagnosis and prognosis of polyomavirus-associated nephropathy. Kidney Int, 2003, 64(2): 665-673
|
/
| 〈 |
|
〉 |