Successful kidney transplantation after desensitization using plasmapheresis, low-dose intravenous immunoglobulin, and rituximab in highly sensitized patients: A single-center experience

M. K. Jin, J. H. Cho, O. Kwon, K. D. Hong, J. Y. Choi, S. H. Yoon, S. H. Park, Y. L. Kim, C. D. Kim

Research output: Contribution to journalArticle

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Abstract

Background: For many highly allosensitized renal transplant candidates, an acceptable donor is never identified, and the patient remains on dialysis indefinitely. In an attempt to ameliorate this situation, several desensitization protocols have been developed that permit positive-crossmatch kidney transplantation. Here, we report our experiences of living donor kidney transplantation in highly sensitized patients. Methods: We treated seven highly sensitized patients between March 2003 and September 2009. All patients underwent desensitization using pretransplant plasmapheresis (PP) and low-dose intravenous immunoglobulin (IVIG; 100 mg/kg) with rituximab (six patients) or without rituximab (one patient). Demographics, immunologic characteristics of patients, allograft function, acute rejection (AR) episodes, survival, and adverse events were evaluated. Results: Seven patients with positive-crossmatch tests or high levels of panel-reactive antibody (PRA) were included. Their mean age was 51.4 ± 3.3 years. The average number of human leukocyte antigen mismatchs was 3.4 ± 0.5. The mean percent PRA was 41.7% ± 6.1%. Six patients were crossmatch-positive, and one patient was crossmatch-negative but had high PRA levels. The mean follow-up period was 33.2 ± 5.4 months after transplantation. The all patients showed no AR episodes for follow-up period, and the patient and graft survival rates were 100%. The mean serum creatinine concentration at last follow-up was 0.92 ± 0.11 mg/dL. Conclusions: Our experiences suggest that the combination of PP and low-dose IVIG with or without rituximab may prove effective as a desensitization regimen for positive-crossmatch and/or highly sensitized living donor renal transplant recipients. Further investigations are needed to evaluate the long-term clinical efficacy and safety of this approach.

Original languageEnglish
Pages (from-to)200-203
Number of pages4
JournalTransplantation Proceedings
Volume44
Issue number1
DOIs
StatePublished - 2012 Jan 1

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Plasmapheresis
Intravenous Immunoglobulins
Kidney Transplantation
Living Donors
Rituximab
Antibodies
Kidney
Graft Survival
HLA Antigens
Allografts
Dialysis
Creatinine
Survival Rate
Transplantation
Demography
Tissue Donors

Cite this

Jin, M. K. ; Cho, J. H. ; Kwon, O. ; Hong, K. D. ; Choi, J. Y. ; Yoon, S. H. ; Park, S. H. ; Kim, Y. L. ; Kim, C. D. / Successful kidney transplantation after desensitization using plasmapheresis, low-dose intravenous immunoglobulin, and rituximab in highly sensitized patients : A single-center experience. In: Transplantation Proceedings. 2012 ; Vol. 44, No. 1. pp. 200-203.
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abstract = "Background: For many highly allosensitized renal transplant candidates, an acceptable donor is never identified, and the patient remains on dialysis indefinitely. In an attempt to ameliorate this situation, several desensitization protocols have been developed that permit positive-crossmatch kidney transplantation. Here, we report our experiences of living donor kidney transplantation in highly sensitized patients. Methods: We treated seven highly sensitized patients between March 2003 and September 2009. All patients underwent desensitization using pretransplant plasmapheresis (PP) and low-dose intravenous immunoglobulin (IVIG; 100 mg/kg) with rituximab (six patients) or without rituximab (one patient). Demographics, immunologic characteristics of patients, allograft function, acute rejection (AR) episodes, survival, and adverse events were evaluated. Results: Seven patients with positive-crossmatch tests or high levels of panel-reactive antibody (PRA) were included. Their mean age was 51.4 ± 3.3 years. The average number of human leukocyte antigen mismatchs was 3.4 ± 0.5. The mean percent PRA was 41.7{\%} ± 6.1{\%}. Six patients were crossmatch-positive, and one patient was crossmatch-negative but had high PRA levels. The mean follow-up period was 33.2 ± 5.4 months after transplantation. The all patients showed no AR episodes for follow-up period, and the patient and graft survival rates were 100{\%}. The mean serum creatinine concentration at last follow-up was 0.92 ± 0.11 mg/dL. Conclusions: Our experiences suggest that the combination of PP and low-dose IVIG with or without rituximab may prove effective as a desensitization regimen for positive-crossmatch and/or highly sensitized living donor renal transplant recipients. Further investigations are needed to evaluate the long-term clinical efficacy and safety of this approach.",
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Successful kidney transplantation after desensitization using plasmapheresis, low-dose intravenous immunoglobulin, and rituximab in highly sensitized patients : A single-center experience. / Jin, M. K.; Cho, J. H.; Kwon, O.; Hong, K. D.; Choi, J. Y.; Yoon, S. H.; Park, S. H.; Kim, Y. L.; Kim, C. D.

In: Transplantation Proceedings, Vol. 44, No. 1, 01.01.2012, p. 200-203.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Successful kidney transplantation after desensitization using plasmapheresis, low-dose intravenous immunoglobulin, and rituximab in highly sensitized patients

T2 - A single-center experience

AU - Jin, M. K.

AU - Cho, J. H.

AU - Kwon, O.

AU - Hong, K. D.

AU - Choi, J. Y.

AU - Yoon, S. H.

AU - Park, S. H.

AU - Kim, Y. L.

AU - Kim, C. D.

PY - 2012/1/1

Y1 - 2012/1/1

N2 - Background: For many highly allosensitized renal transplant candidates, an acceptable donor is never identified, and the patient remains on dialysis indefinitely. In an attempt to ameliorate this situation, several desensitization protocols have been developed that permit positive-crossmatch kidney transplantation. Here, we report our experiences of living donor kidney transplantation in highly sensitized patients. Methods: We treated seven highly sensitized patients between March 2003 and September 2009. All patients underwent desensitization using pretransplant plasmapheresis (PP) and low-dose intravenous immunoglobulin (IVIG; 100 mg/kg) with rituximab (six patients) or without rituximab (one patient). Demographics, immunologic characteristics of patients, allograft function, acute rejection (AR) episodes, survival, and adverse events were evaluated. Results: Seven patients with positive-crossmatch tests or high levels of panel-reactive antibody (PRA) were included. Their mean age was 51.4 ± 3.3 years. The average number of human leukocyte antigen mismatchs was 3.4 ± 0.5. The mean percent PRA was 41.7% ± 6.1%. Six patients were crossmatch-positive, and one patient was crossmatch-negative but had high PRA levels. The mean follow-up period was 33.2 ± 5.4 months after transplantation. The all patients showed no AR episodes for follow-up period, and the patient and graft survival rates were 100%. The mean serum creatinine concentration at last follow-up was 0.92 ± 0.11 mg/dL. Conclusions: Our experiences suggest that the combination of PP and low-dose IVIG with or without rituximab may prove effective as a desensitization regimen for positive-crossmatch and/or highly sensitized living donor renal transplant recipients. Further investigations are needed to evaluate the long-term clinical efficacy and safety of this approach.

AB - Background: For many highly allosensitized renal transplant candidates, an acceptable donor is never identified, and the patient remains on dialysis indefinitely. In an attempt to ameliorate this situation, several desensitization protocols have been developed that permit positive-crossmatch kidney transplantation. Here, we report our experiences of living donor kidney transplantation in highly sensitized patients. Methods: We treated seven highly sensitized patients between March 2003 and September 2009. All patients underwent desensitization using pretransplant plasmapheresis (PP) and low-dose intravenous immunoglobulin (IVIG; 100 mg/kg) with rituximab (six patients) or without rituximab (one patient). Demographics, immunologic characteristics of patients, allograft function, acute rejection (AR) episodes, survival, and adverse events were evaluated. Results: Seven patients with positive-crossmatch tests or high levels of panel-reactive antibody (PRA) were included. Their mean age was 51.4 ± 3.3 years. The average number of human leukocyte antigen mismatchs was 3.4 ± 0.5. The mean percent PRA was 41.7% ± 6.1%. Six patients were crossmatch-positive, and one patient was crossmatch-negative but had high PRA levels. The mean follow-up period was 33.2 ± 5.4 months after transplantation. The all patients showed no AR episodes for follow-up period, and the patient and graft survival rates were 100%. The mean serum creatinine concentration at last follow-up was 0.92 ± 0.11 mg/dL. Conclusions: Our experiences suggest that the combination of PP and low-dose IVIG with or without rituximab may prove effective as a desensitization regimen for positive-crossmatch and/or highly sensitized living donor renal transplant recipients. Further investigations are needed to evaluate the long-term clinical efficacy and safety of this approach.

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