BACKGROUND: : Desensitization protocols have been developed to allow successful kidney transplantation in sensitized recipients. However, a detailed analysis of the impact of these protocols on alloantibody has not been performed. METHODS: : We studied 12 living-donor kidney-transplant recipients with positive antihuman globulin-enhanced complement dependent cytotoxicity (AHG-CDC) crossmatches against their donors. Using a variety of crossmatch techniques and single-antigen flowbeads (SAFBs), we characterized the specificity and amount of alloantibody at baseline before desensitization, after desensitization (using plasmapheresis followed by 100 mg/kg intravenous immunoglobulin, and anti-CD20 antibody), and 4 months after transplantation (after splenectomy and on maintenance immunosuppression). RESULTS: : All 12 patients with a positive baseline AHG-CDC crossmatch were AHG-CDC crossmatch negative at the time of transplant (after desensitization). However, despite desensitization, the majority of patients had low-level donor-specific alloantibodies demonstrable on the day of transplantation by both flow crossmatch (FXM 8/12) and SAFBs (10/11). Four months after transplantation, no patient had a positive AHG-CDC crossmatch, but again the majority had persistent low levels of donor-specific alloantibodies by FXM (6/12) and SAFBs (9/11). No patient experienced hyperacute rejection, and the persistence of low levels of donor-specific alloantibodies did not correlate with the development of humoral rejection in the early posttransplant period. CONCLUSIONS: : Despite desensitization, a majority of positive crossmatch transplant recipients demonstrate low levels of donor-specific alloantibodies both on the day of transplant and 4 months after transplantation. The impact of these antibodies appears to be minimal early after transplant, but their long-term significance bears further study.
BACKGROUND: : Desensitization protocols have been developed to allow successful kidney transplantation in sensitized recipients. However, a detailed analysis of the impact of these protocols on alloantibody has not been performed. METHODS: : We studied 12 living-donor kidney-transplant recipients with positive antihuman globulin-enhanced complement dependent cytotoxicity (AHG-CDC) crossmatches against their donors. Using a variety of crossmatch techniques and single-antigen flowbeads (SAFBs), we characterized the specificity and amount of alloantibody at baseline before desensitization, after desensitization (using plasmapheresis followed by 100 mg/kg intravenous immunoglobulin, and anti-CD20 antibody), and 4 months after transplantation (after splenectomy and on maintenance immunosuppression). RESULTS: : All 12 patients with a positive baseline AHG-CDC crossmatch were AHG-CDC crossmatch negative at the time of transplant (after desensitization). However, despite desensitization, the majority of patients had low-level donor-specific alloantibodies demonstrable on the day of transplantation by both flow crossmatch (FXM 8/12) and SAFBs (10/11). Four months after transplantation, no patient had a positive AHG-CDC crossmatch, but again the majority had persistent low levels of donor-specific alloantibodies by FXM (6/12) and SAFBs (9/11). No patient experienced hyperacute rejection, and the persistence of low levels of donor-specific alloantibodies did not correlate with the development of humoral rejection in the early posttransplant period. CONCLUSIONS: : Despite desensitization, a majority of positive crossmatch transplant recipients demonstrate low levels of donor-specific alloantibodies both on the day of transplant and 4 months after transplantation. The impact of these antibodies appears to be minimal early after transplant, but their long-term significance bears further study.
Authors: M Mengel; B Sis; M Haas; R B Colvin; P F Halloran; L C Racusen; K Solez; L Cendales; A J Demetris; C B Drachenberg; C F Farver; E R Rodriguez; W D Wallace; D Glotz Journal: Am J Transplant Date: 2012-02-02 Impact factor: 8.086
Authors: A R Tambur; D S Ramon; D B Kaufman; J Friedewald; X Luo; B Ho; A Skaro; J Caicedo; D Ladner; T Baker; J Fryer; L Gallon; J Miller; M M Abecassis; J Leventhal Journal: Am J Transplant Date: 2009-06-26 Impact factor: 8.086
Authors: Nisha Shankar; Richard Daly; Jennifer Geske; Sudhir K Kushwaha; Michael Timmons; Lyle Joyce; John Stulak; Manish Gandhi; Walter Kremers; Soon Park; Naveen L Pereira Journal: Transplantation Date: 2013-08-15 Impact factor: 4.939
Authors: Enver Akalin; Rajani Dinavahi; Rex Friedlander; Scott Ames; Graciela de Boccardo; Vinita Sehgal; Bernd Schröppel; Madhu Bhaskaran; Susan Lerner; Marileno Fotino; Barbara Murphy; Jonathan S Bromberg Journal: Clin J Am Soc Nephrol Date: 2008-03-12 Impact factor: 8.237