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Successful renal transplantation despite low levels of donor‐specific HLA class I antibody without IVIg or plasmapheresis
Author(s) -
Bryan Christopher F.,
McDonald Scott B.,
Luger Alan M.,
Shield Charles F.,
Winklhofer Franz T.,
Michael Borkon A.,
Warady Bradley A.,
Aeder Mark I.,
Murillo Daniel
Publication year - 2006
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/j.1399-0012.2006.00563.x
Subject(s) - medicine , plasmapheresis , transplantation , kidney transplantation , human leukocyte antigen , kidney , antibody , panel reactive antibody , splenectomy , immunology , gastroenterology , surgery , antigen , spleen
We prospectively transplanted 10 primary kidney recipients with deceased donor organs (nine kidney and one pancreas/kidney) when their flow cytometric T‐cell IgG, HLA class I donor‐specific crossmatch was positive but the AHG T‐cell crossmatch was negative, with a median follow‐up of 1.8 yr. No pre‐ or peri‐operative IVIg or plasmapheresis was administered to any patient. All but one of the 11 organs transplanted into patients with a flow T + /AHG − crossmatch is currently functioning despite the continued presence of circulating low levels of HLA class I antibody. Flow HLA class I antigen‐coated beads showed the presence of at least one donor‐specific HLA class I antibody at transplantation in each of the 10 cases. No rejections were observed in seven of the 10 cases (70%). Six rejection episodes, four cellular and two humoral, occurred in three patients. Each rejection was successfully treated. The only graft loss occurred in a kidney recipient on day 667 secondary to ischemia to the kidney because of cardiac surgery. Thus, short‐term (one to two years) graft survival in primary transplants was not influenced by low levels of donor‐specific HLA class I antibody present at transplantation and no prophylactic treatment such as IVIg, plasmapheresis, anti‐CD20 or splenectomy was needed peri‐operatively.