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Morath, Christian [Author]; Zeier, Martin [Author]; Süsal, Caner [Author]; Beimler, Jörg [Author]; Opelz, Gerhard [Author]; Scherer, Sabine [Author]; Schmidt, Jan [Author]; Macher-Göppinger, Stephan [Author]; Klein, Katrin [Author]; Sommerer, Claudia [Author]; Schwenger, Vedat [Author]

Living donor kidney transplantation in crossmatch-positive patients enabled by peritransplant immunoadsorption and anti-CD20 therapy

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  • Media type: E-Article
  • Title: Living donor kidney transplantation in crossmatch-positive patients enabled by peritransplant immunoadsorption and anti-CD20 therapy
  • Contributor: Morath, Christian [Author]; Zeier, Martin [Author]; Süsal, Caner [Author]; Beimler, Jörg [Author]; Opelz, Gerhard [Author]; Scherer, Sabine [Author]; Schmidt, Jan [Author]; Macher-Göppinger, Stephan [Author]; Klein, Katrin [Author]; Sommerer, Claudia [Author]; Schwenger, Vedat [Author]
  • Published: 29 February 2012
  • Published in: Transplant international ; 25(2012), 5, Seite 506-517
  • Language: English
  • DOI: 10.1111/j.1432-2277.2012.01447.x
  • Identifier:
  • Keywords: antibody-mediated rejection ; immunoadsorption ; kidney transplantation ; living donor ; positive crossmatch
  • Origination:
  • Footnote:
  • Description: Living donor kidney transplantation in crossmatch-positive patients is a challenge that requires specific measures. Ten patients with positive crossmatch results (n = 9) or negative crossmatch results but strong donor-specific antibodies (DSA; n = 1) were desensitized using immunoadsorption (IA) and anti-CD20 antibody induction. IA was continued after transplantation and accompanied by HLA antibody monitoring and protocol biopsies. After a median of 10 IA treatments, all patients were desensitized successfully and transplanted. Median levels of mean fluorescence intensity (MFI) of Luminex-DSA before desensitization were 6203 and decreased after desensitization and immediately before transplantation to 891. Patients received a median of seven post-transplant IA treatments. At last visit, after a median follow-up of 19 months, 9 of 10 patients had a functioning allograft and a median Luminex-DSA of 149 MFI; serum creatinine was 1.6 mg/dl, and protein to creatinine ratio 0.1. Reversible acute antibody-mediated rejection was diagnosed in three patients. One allograft was lost after the second post-transplant year in a patient with catastrophic antiphospholipid syndrome. We describe a treatment algorithm for desensitization of living donor kidney transplant recipients that allows the rapid elimination of DSA with a low rate of side effects and results in good graft outcome.
  • Access State: Open Access