Living donor kidney transplantation in patients with donor-specific HLA antibodies enabled by anti-CD20 therapy and peritransplant apheresis

• Verfasst von: Klein, Katrin [VerfasserIn]
• Verfasst von: Süsal, Caner [VerfasserIn]
• Verfasst von: Schäfer, Sebastian Markus [VerfasserIn]
• Verfasst von: Becker, Luis Eduardo [VerfasserIn]
• Verfasst von: Beimler, Jörg [VerfasserIn]
• Verfasst von: Schwenger, Vedat [VerfasserIn]
• Verfasst von: Zeier, Martin [VerfasserIn]
• Verfasst von: Schemmer, Peter [VerfasserIn]
• Verfasst von: Macher-Göppinger, Stephan [VerfasserIn]
• Verfasst von: Scherer, Sabine [VerfasserIn]
• Verfasst von: Opelz, Gerhard [VerfasserIn]
• Verfasst von: Morath, Christian [VerfasserIn]
• Titel: Living donor kidney transplantation in patients with donor-specific HLA antibodies enabled by anti-CD20 therapy and peritransplant apheresis
• Verf.angabe: Katrin Klein, Caner Süsal, Sebastian M. Schäfer, Luis Eduardo Becker, Jörg Beimler, Vedat Schwenger, Martin Zeier, Peter Schemmer, Stephan Macher-Goeppinger, Sabine Scherer, Gerhard Opelz, Christian Morath
• E-Jahr: 2013
• Jahr: 26 January 2013
• Umfang: 4 S.
• Fussnoten: Gesehen am 08.06.2022
• Titel Quelle: Enthalten in: Atherosclerosis. Supplements
• Ort Quelle: Amsterdam [u.a.] : Elsevier Science, 2000
• Jahr Quelle: 2013
• Band/Heft Quelle: 14(2013), 1, Seite 199-202
• ISSN Quelle: 1878-5050
• DOI: doi:10.1016/j.atherosclerosissup.2012.10.030
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: Desensitization
• Sach-SW: Donor-specific antibodies
• Sach-SW: Immunoadsorption
• Sach-SW: Kidney transplantation
• Sach-SW: Living donation
• Sach-SW: Rituximab
• K10plus-PPN: 1751707121

Abstract

Objective - Due to increasing waiting times for deceased donor kidneys, living donor kidney transplantation is increasingly performed in the presence of donor-specific antibodies (DSA). - Methods - Twenty-three patients with Luminex-detected DSA were successfully desensitized by anti-CD20 therapy and immunoadsorption (N = 19) or plasmapheresis (N = 4) and received a kidney transplant from a living donor. Twelve of the 23 patients (52%) had a positive CDC and/or ELISA crossmatch result before desensitization. Six patients were negative in CDC as well as ELISA screening but positive in Luminex for DSA. - Results - The 23 patients received a median of 8 apheresis treatments before and 5 treatments after transplantation. Induction therapy was performed with either thymoglobulin (N = 11) or basiliximab (N = 12). The 2-year graft survival rate was 100%. At last follow up, a median of 12 months after transplantation, median serum creatinine was 1.42 mg/dL, median MDRD-GFR 59.5 mL/min/1.73 m2, and median urinary protein-to-creatinine ratio 0.12. Ten out of fourteen patients (71%) who had completed the first year after transplantation by the time of analysis had no DSA by day 360. Acute T-cell mediated rejection was diagnosed in one patient (4%), and antibody-mediated changes were found in 5 patients (22%). Four out of these 5 patients showed evidence of persistent (N = 2) or reemerging plus/minus de novo DSA (N = 2) on day 360, and the 2 patients with persistent DSA lost their allograft subsequently on days 750 and 810, respectively. Infectious complications were infrequent. - Conclusions - Our previously described treatment algorithm for desensitization of living donor kidney transplant recipients with DSA results in good graft outcomes with a low rate of side effects.