Successful desensitization and kidney transplantation in the presence of donor-specific anti-human leukocyte antigen antibodies in kidney transplant recipients
Kidney transplantation has indisputably revamped renal medicine and restored hope among patients coming across fatal end-stage renal disease. However, sensitization of human leukocyte antigen (HLA) triggers extensive immunological fences to successful kidney transplantation and henceforth, transplan...
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Published in | Saudi journal of kidney diseases and transplantation Vol. 31; no. 6; pp. 1432 - 1438 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
Published |
Riyadh, Saudi Arabia
Saudi Center for Organ Transplantation
01.11.2020
Wolters Kluwer India Pvt. Ltd Medknow Publications and Media Pvt. Ltd Medknow Publications & Media Pvt. Ltd Wolters Kluwer Medknow Publications |
Subjects | |
Online Access | Get full text |
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Summary: | Kidney transplantation has indisputably revamped renal medicine and restored
hope among patients coming across fatal end-stage renal disease. However, sensitization of
human leukocyte antigen (HLA) triggers extensive immunological fences to successful kidney
transplantation and henceforth, transplant candidates are frequently demoted to the ever-growing
waiting list owing to preformed donor specific antibodies (DSAs). Over the past few years, the
advent of desensitization protocols has significantly overpowered the immunological barriers and
enhanced the outcomes of kidney transplant recipients with DSAs against HLA. Those desensi-
tization protocols include combination of plasmapheresis, high-dose intravenous immunoglobulin
(IVIG), low-dose IVIG, rituximab, and/or bortezomib. These immunomodulatory treatments
either eliminate DSAs or prevent their production. Lately, our transplant center developed and
used a desensitization protocol (Two sessions of plasmapheresis on day 1 and 2 → injection
rituximab on day 2 after plasmapheresis →no plasmapheresis on day 3 → eight sessions of
plasmapheresis after day 3 and IVIG 100 mg/Kg/dose after each session of plasmapheresis →
repeat HLA antibody detection test to confirm if DSAs are present against HLA with median
fluorescence intensity (MFI)values <1000 and complement dependent cytotoxicity (CDC)
crossmatch is negative for both T and B lymphocytes; if NO then continue plasmapheresis
sessions with IVIG 100 mg/kg/dose till MFI values are <1000 and CDC crossmatch is negative
for both T and B lymphocytes or if YES then proceed for transplantation → repeat dose of
rituximab post-transplantation) to evaluate its effectiveness in improving kidney function in
patients post-desensitization and kidney transplantation. |
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Bibliography: | ObjectType-Case Study-2 SourceType-Scholarly Journals-1 ObjectType-Feature-4 content type line 23 ObjectType-Report-1 ObjectType-Article-3 |
ISSN: | 1319-2442 2320-3838 |
DOI: | 10.4103/1319-2442.308365 |