Abstract: SA-PO020
HLA Desensitization Using Rituximab/Immunoadsorption Before Kidney Transplantation
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
Author
- Rostaing, Lionel, Pôle DIGIDUNE, La Tronche, France
Background
Many kidney-transplant (KT) candidates are sensitized against HLA-antigens, making it difficult to find a suitable HLA-compatible donor. Pretransplant HLA-desensitization strategies have shown improved patient survival after transplantation.
This single-centre study included 14 KT candidates (of which seven had a potential living-donor) that underwent kidney transplantation after desensitization comprising two rituximab injections (375 mg/m2) with concomitant immunosuppression [tacrolimus + mycophenolic acid + steroids, and semi-specific immunoadsorption (IA) (GlobaffinÒ columns)].
Methods
IA sessions were performed until anti-HLA alloantibodies become ≤3,000 mean fluorescent intensity (MFI). At transplantation, all patients were induced with ATG. On average, recipients of a living-kidney had 12 (12-15) pretransplant IA sessions; at transplant their donor-specific alloantibodies (DSA) had MFI of ≤3,000 except for 2 with no rebound at posttransplant. Recipients of deceased donors had 15 (8-83) pretransplant IA sessions; all of them had a DSA at transplantation; however, MFI was ≤4,000 in all cases but one (anti-DPA1 at 7,000). After transplantation, there was no prophylactic IA therapy in both groups.
Results
No living-kidney recipients and one deceased-donor recipient had antibody-mediated rejections (ABMR), which was successfully treated with eculizumab. Follow-up kidney biopsies (at a median of 12 months posttransplantation) were normal except for two cases in which there were signs of subclinical ABMR. There was no significant infectious complications.
Conclusion
Semi-specific immunoadsorption was very effective at achieving HLA desensitization.