Abstract
Many patients who have an otherwise acceptable living-kidney donor do not undergo transplantation because of the presence of antibodies against the donor cells resulting in a positive crossmatch. In the current study, 14 patients with a positive cytotoxic crossmatch (titer ≤1:16) against their living donor underwent a regimen including pretransplant plasmapheresis, intravenous immunoglobulin, rituximab and splenectomy. Eleven of 14 grafts (79%) are functioning well 30-600 days after transplantation. Two grafts were lost to accelerated vasculopathy and one was lost to death with good function. No hyperacute or cellular rejections occurred. Antibody-mediated rejection occurred in six patients [two clinical (14%) and four subclinical (29%)] and was reversible with plasmapheresis and steroids. Our results suggest that selected crossmatch-positive patients can be transplanted successfully with living-donor kidney allografts, using a protocol of pretransplant plasmapheresis, intravenous immunoglobulin, rituximab and splenectomy. Longer follow-up will be needed, but the absence of anti-donor antibody and good early outcomes are encouraging.
Original language | English (US) |
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Pages (from-to) | 1017-1023 |
Number of pages | 7 |
Journal | American Journal of Transplantation |
Volume | 3 |
Issue number | 8 |
DOIs | |
State | Published - Aug 2003 |
Keywords
- Alloantibody
- Intravenous immunoglobulin
- Kidney transplantation
- Plasmapheresis
- Positive crossmatch
- Sensitized patient
ASJC Scopus subject areas
- Immunology and Allergy
- Transplantation
- Pharmacology (medical)