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Long‐term results of desensitization protocol with and without rituximab in sensitized kidney transplant recipients
Author(s) -
Green Hefziba,
Nesher Eviatar,
Aizner Sigal,
Israeli Moshe,
Klein Tirza,
Zakai Hana,
Rahamimov Ruth,
RozenZvi Benaya,
Mor Eytan
Publication year - 2019
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.13562
Subject(s) - medicine , desensitization (medicine) , rituximab , plasmapheresis , surgery , urology , gastroenterology , renal function , kidney transplantation , kidney , immunology , antibody , receptor
Background Desensitization protocols have been developed in order to overcome the immunological barrier of donor‐specific anti‐HLA antibodies (DSA). Methods During 2006‐2012, we implemented a program for desensitizing sensitized (positive DSA, negative NIH‐CDC crossmatch) living‐donor recipients. The long‐term outcome of 36 sensitized recipients, treated with IVIG and plasmapheresis (PP), with or without rituximab (added when > 7500 MFI), was compared to 252 non‐sensitized living‐donor recipients. Results Median peak DSA level before desensitization was 7223 (range 3567‐16 000) MFI. During a mean follow‐up of 121.9 months, graft loss occurred in 6/36 (17%) of the sensitized and 15/251 (6%) of the non‐sensitized recipients ( P = 0.021). Five‐year and 10‐year death‐censored graft survival rates were 85% and 81% compared to 95% and 92%, respectively, for the non‐sensitized recipients. There was no difference in recipients’ survival. Slightly more episodes of acute rejection occurred in the sensitized group but had not influence on graft survival. At the last follow‐up, 28 recipients had functioning graft; seventeen (47%) did not have detectable DSA. Eleven recipients had excellent graft function despite having detectable DSA. Conclusion The long‐term outcomes of sensitized recipients who underwent desensitization are encouraging. Adding rituximab to PP + IVIG in candidates with very high titers may result in improved outcome.