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Successful deceased donor renal transplant in a sensitized pediatric recipient with the use of plasmapheresis
Author(s) -
Pradhan Madhura,
Raffaelli Ryan M.,
Lind Curt,
Meyers Kevin E. C.,
Kaplan Bernard S.,
Baluarte Hobart J.,
Monos Dimitri
Publication year - 2008
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/j.1399-3046.2008.00938.x
Subject(s) - medicine , plasmapheresis , desensitization (medicine) , transplantation , kidney transplantation , renal transplant , surgery , renal function , antibody , immunology , receptor
Sensitization following renal transplant is a significant barrier to repeat transplantation in children. We report a successful DD renal transplant, with the use of PP, in an 11‐yr‐old girl who became highly sensitized following a prior failed transplant. She received PP treatments after failure of high‐dose IVIg (Gamimune ® ). We established the effectiveness of PP by attaining a 0% PRA and negative cross‐matches after five PP treatments. Subsequently, our patient underwent a second round of scheduled PP. When the PRA was 0%, unacceptable antigens were removed from the UNOS wait list, PP was continued, and a kidney became available within 10 days. The final flow cytometry cross‐match with the eventual donor was negative. This success demonstrates that coordination of desensitization by PP and advanced laboratory monitoring techniques with recent policies regarding allocation of organs to pediatric patients provides new opportunities for children awaiting transplantation. Since the transplant, our patient sustained a low‐titer increase of anti‐HLA antibodies. However, she has had no episodes of acute rejection and has maintained excellent graft function more than 17 months later.