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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front Med    2011, Vol. 5 Issue (1) : 80-85     DOI: 10.1007/s11684-011-0115-0
RESEARCH ARTICLE |
Successful kidney transplantation in highly sensitized patients
Weijie ZHANG, Dong CHEN, Zhishui CHEN, Fanjun ZENG, Changsheng MING, Zhengbin LIN, Ping ZHOU, Gang CHEN, Xiaoping CHEN()
Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Key Laboratory of Organ Transplantation, Ministry of Education and Ministry of Health, Wuhan 430030, China
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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 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.

Keywords Kidney transplantation      desensitization     
Corresponding Authors: CHEN Xiaoping,Email:chenxp@medmail.com.cn   
Issue Date: 05 March 2011
URL:  
http://academic.hep.com.cn/fmd/EN/10.1007/s11684-011-0115-0     OR     http://academic.hep.com.cn/fmd/EN/Y2011/V5/I1/80
Age (mean±SD)43.6±7.4
Sex (M:F)8∶6
Etiology of renal failureChronic glomerulonephritis
Hypertension
Diabetes
Polycystic kidney disease
No. of Tx (1st:2nd)4∶10
HLA MM No. (mean±SD)2.7±1.4
Previous transfusion9
Previous transplantation10
Previous pregnancy4
Tab.1  Patient and transplant-related characteristics
Fig.1  Changes in PRA levels before and after desensitization treatment. All patients showed a decrease in PRA levels. The mean decreases in PRA class I and class II levels were 43.6% and 38.5% respectively.
Fig.2  Changes in mean serum creatinine concentration and GFR levels in functioning allografts. Serum creatinine and GFR were 886±114.1μmol/L and 33.2±1.6 mL/min ( = 14) at 1st day post-transplantation respectively, and serum creatinine and GRF were 101±19μmol/L and 45.5±1.8 mL/min ( = 13) at 12 months post-transplantation respectively.
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