PMID- 27932097
OWN - NLM
STAT- MEDLINE
DCOM- 20170501
LR  - 20181202
IS  - 1873-2623 (Electronic)
IS  - 0041-1345 (Linking)
VI  - 48
IP  - 9
DP  - 2016 Nov
TI  - Desensitization Protocol in Recipients of Deceased Kidney Donor With 
      Donor-Specific Antibody-Low Titers.
PG  - 2880-2883
LID - S0041-1345(16)30667-4 [pii]
LID - 10.1016/j.transproceed.2016.07.050 [doi]
AB  - BACKGROUND: Kidney transplantation is the better option for end-stage renal 
      disease (ESRD), but for patients with human leukocyte antigen (HLA) 
      sensitization, the wait times are significantly longer than for patients without 
      antibodies. Many desensitization protocols have been described involving strong 
      immunosuppression, the use of apheresis, and B-cell-modulating therapies. We have 
      designed a desensitization protocol from day 0 for deceased donor kidney 
      transplantation. Our aim was to present our initial experience with five kidney 
      transplant patients. METHODS: All patients had a negative complement-dependent 
      cytotoxicity cross-match. The desensitization protocol included five to seven 
      doses of thymoglobulin (1.25 mg/kg) and three sessions of plasmapheresis (PP) 
      within the first week after transplantation, with intravenous immunoglobulin (500 
      mg/kg) after each PP session and one dose of rituximab on day 8. The presence of 
      donor-specific antibodies (DSA) was analyzed by use of Luminex technology; levels 
      between 1000 and 3000 mean fluorescence intensity were considered for 
      desensitization. RESULTS: The median age was 44 years and median renal 
      replacement therapy time was 9 years. All recipients presented 1 to 3 DSA 
      specificities. There were no severe side effects related to PP, infusion of 
      intravenous immunoglobulin, or rituximab. The median follow-up period was 19.3 
      months. Median serum creatinine level at last follow-up was 1.7 mg/dL. A kidney 
      biopsy was performed in all patients. Graft and patient survival was 100%. 
      CONCLUSIONS: Until now, few data are available concerning whether 
      HLA-incompatible kidney transplantation after desensitization would benefit 
      patients with ERSD. The desensitization strategy using the combination of PP, low 
      doses of intravenous immunoglobulin, and rituximab at our center resulted in a 
      satisfactory clinical outcome.
CI  - Copyright A(c) 2016 Elsevier Inc. All rights reserved.
FAU - Kanter Berga, J
AU  - Kanter Berga J
AD  - Nephrology Department, Hospital Dr Peset, Valencia, Spain. Electronic address: 
      julikanter@gmail.com.
FAU - Sancho Calabuig, A
AU  - Sancho Calabuig A
AD  - Nephrology Department, Hospital Dr Peset, Valencia, Spain.
FAU - Gavela Martinez, E
AU  - Gavela Martinez E
AD  - Nephrology Department, Hospital Dr Peset, Valencia, Spain.
FAU - Puig Alcaraz, N
AU  - Puig Alcaraz N
AD  - HLA Department, Centro de transfusiones de la Comunidad Valenciana, Valencia, 
      Spain.
FAU - Avila Bernabeu, A
AU  - Avila Bernabeu A
AD  - Nephrology Department, Hospital Dr Peset, Valencia, Spain.
FAU - Crespo Albiach, J
AU  - Crespo Albiach J
AD  - Nephrology Department, Hospital Dr Peset, Valencia, Spain.
FAU - Molina Vila, P
AU  - Molina Vila P
AD  - Nephrology Department, Hospital Dr Peset, Valencia, Spain.
FAU - Beltran Catalan, S
AU  - Beltran Catalan S
AD  - Nephrology Department, Hospital Dr Peset, Valencia, Spain.
FAU - Pallardo Mateu, L
AU  - Pallardo Mateu L
AD  - Nephrology Department, Hospital Dr Peset, Valencia, Spain.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Transplant Proc
JT  - Transplantation proceedings
JID - 0243532
RN  - 0 (Antibodies)
RN  - 0 (Antilymphocyte Serum)
RN  - 0 (HLA Antigens)
RN  - 0 (Immunoglobulins, Intravenous)
RN  - 0 (Immunologic Factors)
RN  - 0 (Immunosuppressive Agents)
RN  - 4F4X42SYQ6 (Rituximab)
RN  - D7RD81HE4W (thymoglobulin)
SB  - IM
MH  - Adult
MH  - Antibodies/analysis/*immunology
MH  - Antilymphocyte Serum/administration & dosage
MH  - Desensitization, Immunologic/*methods
MH  - Drug Administration Schedule
MH  - Female
MH  - Follow-Up Studies
MH  - Graft Rejection/immunology/*prevention & control
MH  - Graft Survival/drug effects
MH  - HLA Antigens/analysis/*immunology
MH  - Humans
MH  - Immunoglobulins, Intravenous/administration & dosage
MH  - Immunologic Factors/administration & dosage
MH  - Immunosuppressive Agents/administration & dosage
MH  - Kidney/drug effects/immunology/pathology
MH  - Kidney Failure, Chronic/surgery
MH  - Kidney Transplantation/*methods
MH  - Male
MH  - Middle Aged
MH  - Plasmapheresis
MH  - Rituximab/administration & dosage
EDAT- 2016/12/10 06:00
MHDA- 2017/05/02 06:00
CRDT- 2016/12/10 06:00
PHST- 2016/06/15 00:00 [received]
PHST- 2016/07/27 00:00 [accepted]
PHST- 2016/12/10 06:00 [entrez]
PHST- 2016/12/10 06:00 [pubmed]
PHST- 2017/05/02 06:00 [medline]
AID - S0041-1345(16)30667-4 [pii]
AID - 10.1016/j.transproceed.2016.07.050 [doi]
PST - ppublish
SO  - Transplant Proc. 2016 Nov;48(9):2880-2883. doi: 
      10.1016/j.transproceed.2016.07.050.