BACKGROUND: Sensitization to human leukocyte antigens remains an important barrier to successful renal transplantation. MATERIALS AND METHODS: Herein we describe our center's experience with a plasmapheresis-based desensitization protocol for highly sensitized patients. Twenty-nine patients had a positive T-cell or positive B-cell lymphocytotoxicity crossmatch against their donors. In some cases, baseline crossmatches were of high titer (e.g., 11 had baseline titers > or =1:32). RESULTS: Twenty-eight of 29 patients were rendered T-cell crossmatch negative and B-cell crossmatch negative/low positive and transplanted. None had hyperacute rejection but 11 (39%) had acute antibody mediated rejection. Median follow-up is 22 months: 25 of the 28 (89%) of allografts are still functioning with mean plasma creatinine 1.5 mg/dL. There was one death because of the transplant or immunsuppression, one case of cytomegalovirus disease and no cases of lymphoproliferative disease. CONCLUSION: This series provides further evidence of the high efficacy of plasmapheresis-based desensitization protocols. Even patients with high baseline crossmatch titers can be successfully desensitized and transplanted. Short- and medium-term outcomes are encouraging but longer-term data are needed.
BACKGROUND: Sensitization to human leukocyte antigens remains an important barrier to successful renal transplantation. MATERIALS AND METHODS: Herein we describe our center's experience with a plasmapheresis-based desensitization protocol for highly sensitized patients. Twenty-nine patients had a positive T-cell or positive B-cell lymphocytotoxicity crossmatch against their donors. In some cases, baseline crossmatches were of high titer (e.g., 11 had baseline titers > or =1:32). RESULTS: Twenty-eight of 29 patients were rendered T-cell crossmatch negative and B-cell crossmatch negative/low positive and transplanted. None had hyperacute rejection but 11 (39%) had acute antibody mediated rejection. Median follow-up is 22 months: 25 of the 28 (89%) of allografts are still functioning with mean plasma creatinine 1.5 mg/dL. There was one death because of the transplant or immunsuppression, one case of cytomegalovirus disease and no cases of lymphoproliferative disease. CONCLUSION: This series provides further evidence of the high efficacy of plasmapheresis-based desensitization protocols. Even patients with high baseline crossmatch titers can be successfully desensitized and transplanted. Short- and medium-term outcomes are encouraging but longer-term data are needed.
Authors: Babak J Orandi; Xun Luo; Allan B Massie; Jacqueline M Garonzik-Wang; Bonne E Lonze; Rizwan Ahmed; Kyle J Van Arendonk; Mark D Stegall; Stanley C Jordan; Jose Oberholzer; Ty B Dunn; Lloyd E Ratner; Sandip Kapur; Ronald P Pelletier; John P Roberts; Marc L Melcher; Pooja Singh; Debra L Sudan; Marc P Posner; Jose M El-Amm; Ron Shapiro; Matthew Cooper; George S Lipkowitz; Michael A Rees; Christopher L Marsh; Bashir R Sankari; David A Gerber; Paul W Nelson; Jason Wellen; Adel Bozorgzadeh; A Osama Gaber; Robert A Montgomery; Dorry L Segev Journal: N Engl J Med Date: 2016-03-10 Impact factor: 91.245
Authors: Zijian Zhang; Nancy A Wilson; Raghavan Chinnadurai; Sarah E Panzer; Robert R Redfield; Shannon R Reese; Jacques Galipeau; Arjang Djamali Journal: Transplant Direct Date: 2018-08-27
Authors: William H Marks; Nizam Mamode; Robert A Montgomery; Mark D Stegall; Lloyd E Ratner; Lynn D Cornell; Ajda T Rowshani; Robert B Colvin; Bradley Dain; Judith A Boice; Denis Glotz Journal: Am J Transplant Date: 2019-04-19 Impact factor: 8.086
Authors: Arjang Djamali; Brenda L Muth; Thomas M Ellis; Maha Mohamed; Luis A Fernandez; Karen M Miller; Janet M Bellingham; Jon S Odorico; Joshua D Mezrich; John D Pirsch; Tony M D'Alessandro; Vijay Vidyasagar; R Michael Hofmann; Jose R Torrealba; Dixon B Kaufman; David P Foley Journal: Kidney Int Date: 2013-02-27 Impact factor: 10.612