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

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. 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. 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. 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.

Jin MK ，Cho JH ，Kwon O ，Hong KD ，Choi JY ，Yoon SH ，Park SH ，Kim YL ，Kim CD ... -  《-》

Kidney transplant in highly sensitized patients after desensitization with plasmapheresis and low-dose intravenous immunoglobulin.

Yuan XP ，Wang CX ，Gao W ，Fu Q ，He XS ... -  《-》

Highly Sensitized Patients: Miami Transplant Institute Experience.

Mattiazzi AD ，Centeno A ，Amador A ，Fernandez-Bango C ，Scowby CD ，O'Rourke M ，Hill-Matthie T ，Patel R ，Barrios F ，Ruiz P ，Chen L ，Saghesima J ，Ciancio G ，Burke GW ，Goldstein M ，Chandar J ，Contreras G ，Roth D ，Kupin W ，Guerra G ，Vianna R ... -  《-》

Kinetics of cellular and humoral immunity in a successful case of positive crossmatch kidney transplantation: a case report.

A positive crossmatch remains one of the major barriers to successful kidney transplantation. Highly sensitized patients are at greater risk of hyperacute rejection and subsequent graft loss after transplantation. Although recent advances in desensitization therapy allow kidney transplantation in these patients, the success rate is quite low. Herein, we have reported a successful case of positive crossmatch living donor kidney transplantation using a desensitization protocol with an immune monitoring assay. A 42-year-old woman with end-stage renal disease due to IgA nephropathy had been on hemodialysis for 36 months. She showed positive T-cell and B-cell cytotoxic crossmatches with her husband owing to pretransplantation blood transfusions. We performed a preconditioning regimen comprising a single dose of rituximab (375 mg/m(2)) combined with double-filtration plasmapheresis (DFPP) followed by low doses of intravenous immunoglobulin (DFPP/IVIG treatment). Tacrolimus (target trough level, 5-10 ng/mL) and mycophenolate mofetil (1500 mg/body) were started 2 weeks before the DFPP/IVIG treatment. After 6 DFPP/IVIG sessions, the crossmatch became negative. An induction quadruple immunosuppression protocol included tacrolimus, mycophenolate mofetil, basiliximab, and methylprednisolone. After the transplantation, the patient's immune status was evaluated regularly by mixed lymphocyte reactions (MLR) using an intracellular carboxyfluorescein diacetate succinimidyl ester (CFSE)-labeling technique (CFSE-MLR assay) and immunosuppressant therapy was adjusted accordingly. During the observation period, neither antibody-mediated rejection nor acute cellular rejection was encountered in this patient.

Tanimine N ，Ide K ，Yamashita M ，Tanaka Y ，Igarashi Y ，Banshodani M ，Tazawa H ，Basnet NB ，Doskali M ，Onoe T ，Tashiro H ，Ohdan H ... -  《-》

Desensitization protocol for highly sensitized renal transplant patients: a single-center experience.

Kute VB ，Vanikar AV ，Trivedi HL ，Shah PR ，Goplani KR ，Patel HV ，Gumber MR ，Patel RD ，Kanodia KV ，Suthar KS ，Trivedi VB ，Modi PR ... -  《-》