Overcoming a positive crossmatch in living-donor kidney transplantation

James M. Gloor, Steven R. DeGoeyb, Alvaro A. Pineda, S. Breanndan Moore, Mikel Prieto, Scott Nyberg, Timothy S. Larson, Matthew D. Griffin, Stephen C Textor, Jorge A. Velosa, Thomas R. Schwab, Lynette A. Fix, Mark D Stegall

Research output: Contribution to journalArticle

215 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)1017-1023
Number of pages7
JournalAmerican Journal of Transplantation
Volume3
Issue number8
DOIs
StatePublished - Aug 2003

Fingerprint

Living Donors
Kidney Transplantation
Plasmapheresis
Intravenous Immunoglobulins
Splenectomy
Transplantation
Tissue Donors
Transplants
Kidney
Antibodies
Allografts
Anti-Idiotypic Antibodies
Steroids
Rituximab

Keywords

  • Alloantibody
  • Intravenous immunoglobulin
  • Kidney transplantation
  • Plasmapheresis
  • Positive crossmatch
  • Sensitized patient

ASJC Scopus subject areas

  • Immunology

Cite this

Overcoming a positive crossmatch in living-donor kidney transplantation. / Gloor, James M.; DeGoeyb, Steven R.; Pineda, Alvaro A.; Moore, S. Breanndan; Prieto, Mikel; Nyberg, Scott; Larson, Timothy S.; Griffin, Matthew D.; Textor, Stephen C; Velosa, Jorge A.; Schwab, Thomas R.; Fix, Lynette A.; Stegall, Mark D.

In: American Journal of Transplantation, Vol. 3, No. 8, 08.2003, p. 1017-1023.

Research output: Contribution to journalArticle

Gloor, JM, DeGoeyb, SR, Pineda, AA, Moore, SB, Prieto, M, Nyberg, S, Larson, TS, Griffin, MD, Textor, SC, Velosa, JA, Schwab, TR, Fix, LA & Stegall, MD 2003, 'Overcoming a positive crossmatch in living-donor kidney transplantation', American Journal of Transplantation, vol. 3, no. 8, pp. 1017-1023. https://doi.org/10.1034/j.1600-6143.2003.00180.x
Gloor, James M. ; DeGoeyb, Steven R. ; Pineda, Alvaro A. ; Moore, S. Breanndan ; Prieto, Mikel ; Nyberg, Scott ; Larson, Timothy S. ; Griffin, Matthew D. ; Textor, Stephen C ; Velosa, Jorge A. ; Schwab, Thomas R. ; Fix, Lynette A. ; Stegall, Mark D. / Overcoming a positive crossmatch in living-donor kidney transplantation. In: American Journal of Transplantation. 2003 ; Vol. 3, No. 8. pp. 1017-1023.
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