Abstract: SA-PO023
Outcomes Following Living Donor Kidney Transplantation in Patients with Donor-Specific HLA Antibodies After Desensitization with Immunoadsorption
Session Information
- Transplantation: Clinical Outcomes
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1802 Transplantation: Clinical
Authors
- Kälble, Florian, University Hospital Heidelberg, Heidelberg, Germany
- Pego silva, Luiza, University Hospital Heidelberg, Heidelberg, Germany
- Speer, Claudius, University Hospital Heidelberg, Heidelberg, Germany
- Nusshag, Christian, University Hospital Heidelberg, Heidelberg, Germany
- Schaier, Matthias, University Hospital Heidelberg, Heidelberg, Germany
- Zeier, Martin G., University Hospital Heidelberg, Heidelberg, Germany
- Mehrabi, Arianeb, University Hospital Heidelberg, Heidelberg, BW, Germany
- Süsal, Caner, University Hospital Heidelberg, Heidelberg, BW, Germany
- Morath, Christian, University Hospital Heidelberg, Heidelberg, Germany
Background
Due to the current organ shortage, living donor kidney transplantation is increasingly performed over human leukocyte antigen (HLA) or ABO antibody barriers. Uncertainty still exists concerning the risk for antibody-mediated rejection episodes, possibly limiting long-term graft survival. The present study aimed to evaluate the outcomes of kidney transplantations performed after desensitization in patients with donor-specific HLA antibodies compared to standard risk recipients.
Methods
Thirty-eight sensitized patients were included in the study. Sixteen patients had a positive CDC and/or ELISA crossmatch result with their prospective living donor and 32 patients had Luminex-detected donor-specific HLA antibodies (DSA). Patients were successfully desensitized by immunoadsorption treatment (median of 8 treatments) and anti-CD20 antibody rituximab (N=36) combined with antithymocyte globulin (N=20) or anti-IL2 receptor antibody therapy (N=18). Twelve patients were additionally treated by plasmapheresis. All patients received a kidney transplant from a living donor. Postoperative apheresis was performed in 28 patients. The outcomes of the 38 patients were retrospectively compared to outcomes of 76 standard risk recipients (2:1 matching).
Results
During a median of 8 pretransplant immunoadsorption treatments, IgG was reduced by 98% and IgM by 78% in sensitized patients. After transplantation, sensitized patients showed comparable death-censored graft survival and patient survival compared to standard risk recipients. Infectious complications, surgical complications and rejection rates (18% in both groups) were not significantly different between groups. Median 1-year serum creatinine was with 1.31 mg/dL in sensitized recipients not significantly different to the 1.38 mg/dL in standard risk recipients. One-year urinary protein excretion was also not significantly different with a low 10.8 and 10.5 g/mol creatinine, respectively.
Conclusion
Our desensitization protocol for sensitized living donor kidney transplant recipients results in good graft outcomes with comparable side effects and rejections rates to standard risk recipients.