Kidney Week

Abstract: TH-PO817

Effects of Desensitization Therapy on Acute Rejection and Graft Function in Patients Who Are Hyperimmunized after Receiving a Living-Donor Kidney Transplant

Session Information

• Transplantation: Clinical - 2
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2102 Transplantation: Clinical

Authors

• Castro, Caren, Instituto Mexicano del Seguro Social. UMAE-Centro Medico Nacional de Occidente. Depto Nefrologia y Trasplantes, Guadalajara, JALISCO, Mexico

Caren Castro, MD

• Andrade-Sierra, Jorge, Universidad de Guadalajara Centro Universitario de Ciencias de la Salud, Guadalajara, Jalisco, Mexico

Jorge Andrade-Sierra, MD, PhD

• Reynoso de la Torre, Hugo Leonardo, Instituto Mexicano del Seguro Social. UMAE-Centro Medico Nacional de Occidente. Depto Nefrologia y Trasplantes, Guadalajara, JALISCO, Mexico

Hugo Leonardo Reynoso de la Torre, MD

• Rojas-Campos, Enrique, Instituto Mexicano del Seguro Social. UMAE-Centro Medico Nacional de Occidente. Depto Nefrologia y Trasplantes, Guadalajara, JALISCO, Mexico

Enrique Rojas-Campos, MD

• Evangelista-Carrillo, Luis Alberto, Instituto Mexicano del Seguro Social. UMAE-Centro Medico Nacional de Occidente. Depto Nefrologia y Trasplantes, Guadalajara, JALISCO, Mexico

Luis Alberto Evangelista-Carrillo, MD

• Carvallo Venegas, Mauricio, Instituto Mexicano del Seguro Social. UMAE-Centro Medico Nacional de Occidente. Depto Nefrologia y Trasplantes, Guadalajara, JALISCO, Mexico

Mauricio Carvallo Venegas, MD

• Banda Lopez, Adriana, Instituto Mexicano del Seguro Social. UMAE-Centro Medico Nacional de Occidente. Depto Nefrologia y Trasplantes, Guadalajara, JALISCO, Mexico

Adriana Banda Lopez, MD

• Cerrillos, Jose Ignacio, Instituto Mexicano del Seguro Social. UMAE-Centro Medico Nacional de Occidente. Depto Nefrologia y Trasplantes, Guadalajara, JALISCO, Mexico

Jose Ignacio Cerrillos

• Medina Perez, Miguel, Instituto Mexicano del Seguro Social. UMAE-Centro Medico Nacional de Occidente. Depto Nefrologia y Trasplantes, Guadalajara, JALISCO, Mexico

Miguel Medina Perez, MD

• Muñoz, Diana Laura, Instituto Mexicano del Seguro Social. UMAE-Centro Medico Nacional de Occidente. Depto Nefrologia y Trasplantes, Guadalajara, JALISCO, Mexico

Diana Laura Muñoz

Background

Desensitization therapy may enhance the probability of successful kidney transplantation (KT) and ensure long-term survival for hyperimmunized patients.

Methods

A retrospective cohort included 38 patients ≥18 years with a positive DSA flow crossmatch test. (January 2018 to December 2022). All patients received pre-transplant desensitization using plasmapheresis (PF), immunoglobulins (IG), rituximab (RTX) and maintenance immunosuppressive consisting of mycophenolic acid, prednisone, tacrolimus (TAC) and thymoglobulin. The occurrences of infectious and acute rejection (AR) episodes were registered.

Results

The function of the graft at 12 months was 80 ± 28.5 ml/min/1.73m2 and AR rate was 18.4% (7 patients). The MFI class I of the patients who developed AR was 7001 ± 1269 (p= 0.17), and MFI class II 7083 ± 3264 (p=0.58). Two patients developed hyperacute rejection, both positive in DSA flow crossmatch class II, with a MFI DSA class I 6782 ± 1639 and class II of 8958 ± 5828. The first patient with positive antigen B and DR, and the second patient with positive antigen for C and DR. 36.5% patients had urinary tract infection (UTI), with a cumulative number of UTI events of 27. Four patients developed respiratory tract infections (10.5%), death was reported in 2 of them due to the infection.

Conclusion

The main risk factors were the number of match class II antigens and serum tacrolimus levels at 6 months. The hyperimmunized patients can have an opportunity and access a high-risk transplant, with successful results.

Demographic Characteristics of the Population

DSA: Donor specific antibody, CrS: serum creatinine, UTI: urinary tract infection, CMV: cytomegalovirus.