Low Incidence of Acute Antibody-Mediated Rejection after HLA Desensitization in Living Donor Kidney Transplant Recipients

• Published in: Life (Basel, Switzerland) Vol. 12; no. 12; p. 1993
• Main Authors: Fernández Rivera, Constantino, Rodríguez Magariños, Catuxa, Calvo Rodríguez, María, Ferreiro Hermida, Tamara, Blanco Pardo, Marta, López Muñiz, Andrés, Erráez Guerrero, Sara, García Gago, Leticia, Alonso Hernández, Ángel
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 29.11.2022; MDPI
• Subjects: acute rejection; Antibodies; Antigens; Apheresis; Biopsy; Cytomegalovirus; Cytotoxicity; Desensitization; Disease prevention; Drug therapy; Flow cytometry; Fluorescence; Graft rejection; Health aspects; Hemodialysis; Histocompatibility; Histocompatibility antigen HLA; Histocompatibility antigens; Histocompatibility testing; HLA desensitization; HLA histocompatibility antigens; Human performance; Immunoglobulins; Immunological research; Immunotherapy; Kidney transplantation; Kidney transplants; Kidneys; Leukocytes; Lymphocytes T; Mycophenolic acid; Organ transplant recipients; Patient outcomes; Patients; Peritoneal dialysis; plasma exchange; Rejection; Renal replacement therapy; Risk factors; Rituximab; Statistics; Steroid hormones; Steroids; Tacrolimus; Toxicity; Transplantation; Transplants; Spain; United States > US; HLA desensitization; acute rejection; immunoglobulins; plasma exchange; rituximab
• ISSN: 2075-1729; 2075-1729
• DOI: 10.3390/life12121993

Desensitization allows the performance of human leukocyte antigen (HLA)-incompatible transplants. However, the incidence of acute rejection (AR) is high. This study aims to analyze the incidence of AR after transplantation with HLA-incompatible living donors in patients who underwent desensitization. Patients were immunosuppressed with tacrolimus, mycophenolic acid derivatives, and steroids after being desensitized with rituximab, plasma exchange, and/or immunoadsorption with specific cytomegalovirus immunoglobulins. A negative complement-dependent cytotoxicity or flow cytometry crossmatch and a donor-specific antibody titer < 1000 mean fluorescence intensity (MFI) were used to determine desensitization efficacy. A total of 36 patients underwent desensitization, and 27 (75%) were transplanted. After a follow-up of 58 ± 58 months (Min−Max: 0.13−169.5), five episodes of AR occurred: two antibody-mediated and three T-cell-mediated. No differences were found in baseline calculated panel-reactive antibodies (cPRA), class I or II MFI, number of antibodies, or Relative Intensity Scale (RIS) between AR and non-AR patients. Patients with antibody-mediated AR had higher cPRA (NS), MFI class I (p = 0.07) and class II (p = 0.006), and RIS (p = 0.01). The two patients with antibody-mediated AR and one patient with T-cell-mediated AR lost their grafts. In conclusion, the incidence of acute antibody-mediated rejection after desensitization was 7.4%, which occurred early post-transplantation in patients with high MFI and was associated with early graft loss.