PMID- 28564532
OWN - NLM
STAT- MEDLINE
DCOM- 20180723
LR  - 20181202
IS  - 0890-9016 (Print)
IS  - 0890-9016 (Linking)
VI  - 32
DP  - 2016
TI  - Post-transplant Desensitization for Deceased Donor Kidney Transplant Recipients: 
      A Single Center Experience.
PG  - 143-151
AB  - 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 (MCS) and 117 MCS, respectively. Although acute AMR rates were acceptable 
      (12%), 22% of patients developed chronic AMR. A pre-transplant T-cell FCXM of > 
      200 MCS (p=0.02) or presence of donor specific antibodies (DSA) at most recent 
      follow-up (p=0.02) were associated with graft loss. Current studies with revised 
      protocols utilizing additional DSA information, surveillance biopsies, and 
      proteasome inhibition are ongoing.
CI  - Copyright(c) 2017 by the Terasaki Research Institute.
FAU - Kumar, Dhiren
AU  - Kumar D
AD  - Division of Nephrology, Department of Surgery, Virginia Commonwealth University, 
      Richmond, VA.
FAU - Fattah, Hasan
AU  - Fattah H
AD  - Division of Nephrology, Department of Surgery, Virginia Commonwealth University, 
      Richmond, VA.
FAU - Kimball, Pamela M
AU  - Kimball PM
AD  - Division of Transplant Surgery, Department of Surgery, Virginia Commonwealth 
      University, Richmond, VA.
FAU - LeCorchick, Spencer
AU  - LeCorchick S
AD  - Division of Transplant Surgery, Department of Surgery, Virginia Commonwealth 
      University, Richmond, VA.
FAU - McDougan, Felecia A
AU  - McDougan FA
AD  - Division of Transplant Surgery, Department of Surgery, Virginia Commonwealth 
      University, Richmond, VA.
FAU - King, Anne L
AU  - King AL
AD  - Division of Nephrology, Department of Surgery, Virginia Commonwealth University, 
      Richmond, VA.
FAU - Gupta, Gaurav
AU  - Gupta G
AD  - Division of Nephrology, Department of Surgery, Virginia Commonwealth University, 
      Richmond, VA.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Clin Transpl
JT  - Clinical transplants
JID - 8812419
RN  - 0 (HLA Antigens)
SB  - IM
MH  - *Desensitization, Immunologic
MH  - Graft Rejection
MH  - Graft Survival
MH  - *HLA Antigens
MH  - Histocompatibility Testing
MH  - Humans
MH  - *Kidney Transplantation
OTO - NOTNLM
OT  - antibody-mediated rejection
OT  - desensitization
OT  - donor-specific antibodies
OT  - kidney
OT  - single center
OT  - transplantation
EDAT- 2016/01/01 00:00
MHDA- 2018/07/24 06:00
CRDT- 2017/06/01 06:00
PHST- 2017/06/01 06:00 [entrez]
PHST- 2016/01/01 00:00 [pubmed]
PHST- 2018/07/24 06:00 [medline]
PST - ppublish
SO  - Clin Transpl. 2016;32:143-151.