Successful Renal Transplantation with Desensitization in Highly Sensitized Patients: A Single Center Experience

다국어 초록 (Multilingual Abstract)

Intravenous immunoglobulin (IVIG) and/or plasmapheresis (PP) are effective in preventing

antibody-mediated rejection (AMR) of kidney allografts, but AMR is still a

problem. This study reports our experience in living donor renal transplantation in

highly sensitized patients. Ten patients with positive crossmatch tests or high levels

of panel-reactive antibody (PRA) were included. Eight patients were desensitized

with pretransplant PP and low dose IVIG, and two were additionally treated with rituximab.

Allograft function, number of acute rejection (AR) episodes, protocol biopsy

findings, and the presence of donor-specific antibody (DSA) were evaluated. With

PP/IVIG, six out of eight patients showed good graft function without AR episodes.

Protocol biopsies revealed no evidence of tissue injury or C4d deposits. Of two patients

with AR, one was successfully treated with PP/IVIG, but the other lost graft function

due to de novo production of DSA. Thereafter, rituximab was added to PP/IVIG in

two cases. Rituximab gradually decreased PRA levels and the percentage of peripheral

CD20+ cells. DSA was undetectable and protocol biopsy showed no C4d deposits.

The graft function was stable and there were no AR episodes. Conclusively,

desensitization using PP/IVIG with or without rituximab increases the likelihood

of successful living donor renal transplantation in sensitized recipients.

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