Renal Transplantation in Highly Sensitized Patients: SIUT Experience

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BackgroundSensitization to human leukocyte antigens remains a major barrier to successful renal transplantation.Material and MethodsHerein we describe our experience of seven highly sensitized patients with positive T-cell and B- cell lymphocytotoxicity crossmatch and T and B-cell flow crossmatch for IgG. All seven patients had donor specific antibodies (DSA) against HLA class I or class II antigens detected by Luminex single antigen beads assay (SAB).Desensitization protocol included 7-10 session of plasmapheresis, Low dose IVIgG, single dose of Rituximab and two doses of Bortezomib.ResultsIn all cases CDC and flow crossmatch were negative at the time of transplant. Three patients experienced rejection episode from 18 days to 3 months post-transplant. In a follow-up period of 2 to 12 months post -transplant all allografts are functioning well with mean serum creatinine is 1.25mg/dl.ConclusionThe early results of this study are encouraging. Protocols employed in the current study offer real hope to these patients unlikely to otherwise receive a kidney transplant.

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