Post-transplant Desensitization for Deceased Donor Kidney Transplant Recipients: A Single Center Experience.

Post-transplant Desensitization for Deceased Donor Kidney Transplant Recipients: A Single Center Experience. Clin Transpl. 2016;32:143-151 Authors: Kumar D, Fattah H, Kimball PM, LeCorchick S, McDougan FA, King AL, Gupta G Abstract The highly-sensitized kidney transplant candidate with no available living donors remains at a major disadvantage with decreased access and worse outcomes post-transplant. We have previously reported our initial data on both pre-transplant and post-transplant desensitization. We observed only a modest decline in unacceptable antigens with pretransplant intravenous immunoglobin (IVIG) and rituximab. Due to these observations, we have focused on a peri-operative post-transplant desensitization protocol in our program. Beginning in 2006, we implemented a simple point-based algorithm [variables included: panel reactive antibody (PRA) status; flow cytometric crossmatch (FCXM); and delayed graft function] to identify kidney transplant recipients who would undergo peri-operative plasmapheresis/IVIG to abrogate preformed antibody-mediated allograft rejection (AMR). Our previous results suggested acceptable 5-year outcomes. Here, in an expanded population (N=66), we report an overall death-censored graft survival of 73% at a mean follow-up of 8.5 years post-transplant. Our patients were largely African American (85%) and regrafts (39%), with a median PRA of 88%, and a mean T- and B-FCXM of 97 mean channel shifts (M...
Source: Clinical Transplants - Category: Transplant Surgery Tags: Clin Transpl Source Type: research