An integrative approach for the transplantation of high-risk sensitized patients

• Verfasst von: Morath, Christian [VerfasserIn]
• Verfasst von: Beimler, Jörg [VerfasserIn]
• Verfasst von: Opelz, Gerhard [VerfasserIn]
• Verfasst von: Ovens, Jörg [VerfasserIn]
• Verfasst von: Scherer, Sabine [VerfasserIn]
• Verfasst von: Schmidt, Jan [VerfasserIn]
• Verfasst von: Schmied, Bruno [VerfasserIn]
• Verfasst von: Groß-Weissmann, Marie-Luise [VerfasserIn]
• Verfasst von: Schwenger, Vedat [VerfasserIn]
• Verfasst von: Zeier, Martin [VerfasserIn]
• Verfasst von: Süsal, Caner [VerfasserIn]
• Titel: An integrative approach for the transplantation of high-risk sensitized patients
• Verf.angabe: Christian Morath, Jörg Beimler, Gerhard Opelz, Jörg Ovens, Sabine Scherer, Jan Schmidt, Bruno Schmied, Marie-Luise Gross, Vedat Schwenger, Martin Zeier, and Caner Süsal
• Jahr: 2010
• Umfang: 9 S.
• Fussnoten: Gesehen am 04.05.2023
• Titel Quelle: Enthalten in: Transplantation
• Ort Quelle: Hagerstown, Md. : Lippincott Williams & Wilkins, 1963
• Jahr Quelle: 2010
• Band/Heft Quelle: 90(2010), 6, Seite 645-653
• ISSN Quelle: 1534-6080
• DOI: doi:10.1097/TP.0b013e3181ea3985
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1844578038

Abstract

Background. - Sensitized patients have a lower chance of receiving a crossmatch-negative kidney and, if transplanted, are at risk of antibody-mediated allograft rejection. - Methods. - For safe and timely transplantation of sensitized patients at our center, we developed an integrative algorithm that includes identification of high-risk patients, good human leukocyte antigen match, inclusion in the Eurotransplant Acceptable Mismatch Program when applicable, apheresis, anti-CD20 therapy, posttransplant antibody monitoring, and protocol biopsies. Thirty-four high-risk recipients of a deceased donor kidney (DDK: n=28) or living donor kidney (LDK: n=6) were transplanted using this algorithm. - Results. - One-year graft survival, death-censored graft survival, and patient survival rates in DDK recipients were 92.4%, 96.4%, and 95.8%, respectively. No graft loss or patient death was observed in the six LDK patients. Median serum creatinine at 1 year in DDK and LDK recipients was 1.2 and 1.4 mg/dL, respectively. Eleven DDK and three LDK patients experienced at least one biopsy-proven acute rejection episode, mostly showing borderline changes. Antibody-mediated rejection without graft loss was diagnosed in two DDK and one LDK patients. Delayed graft function was observed in 13 DDK and 1 LDK patients. Infectious complications were infrequent. - Conclusions. - We describe an algorithm for the categorization and treatment of presensitized high-risk patients. This protocol provides effective prevention of antibody-mediated rejection and is associated with a low rate of side effects and good graft outcome.