Medizinische Universität Graz - Research portal
Selected Publication:
SHR Neuro Cancer Cardio Lipid Metab Microb
Klein, K; Süsal, C; Schäfer, SM; Becker, LE; Beimler, J; Schwenger, V; Zeier, M; Schemmer, P; Macher-Goeppinger, S; Scherer, S; Opelz, G; Morath, C.
Living donor kidney transplantation in patients with donor-specific HLA antibodies enabled by anti-CD20 therapy and peritransplant apheresis.
Atheroscler Suppl. 2013; 14(1):199-202
Doi: 10.1016/j.atherosclerosissup.2012.10.030
Web of Science
PubMed
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- Co-authors Med Uni Graz
- Schemmer Peter
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- Abstract:
- Due to increasing waiting times for deceased donor kidneys, living donor kidney transplantation is increasingly performed in the presence of donor-specific antibodies (DSA). Twenty-three patients with Luminex-detected DSA were successfully desensitized by anti-CD20 therapy and immunoadsorption (N = 19) or plasmapheresis (N = 4) and received a kidney transplant from a living donor. Twelve of the 23 patients (52%) had a positive CDC and/or ELISA crossmatch result before desensitization. Six patients were negative in CDC as well as ELISA screening but positive in Luminex for DSA. The 23 patients received a median of 8 apheresis treatments before and 5 treatments after transplantation. Induction therapy was performed with either thymoglobulin (N = 11) or basiliximab (N = 12). The 2-year graft survival rate was 100%. At last follow up, a median of 12 months after transplantation, median serum creatinine was 1.42 mg/dL, median MDRD-GFR 59.5 mL/min/1.73 m(2), and median urinary protein-to-creatinine ratio 0.12. Ten out of fourteen patients (71%) who had completed the first year after transplantation by the time of analysis had no DSA by day 360. Acute T-cell mediated rejection was diagnosed in one patient (4%), and antibody-mediated changes were found in 5 patients (22%). Four out of these 5 patients showed evidence of persistent (N = 2) or reemerging plus/minus de novo DSA (N = 2) on day 360, and the 2 patients with persistent DSA lost their allograft subsequently on days 750 and 810, respectively. Infectious complications were infrequent. Our previously described treatment algorithm for desensitization of living donor kidney transplant recipients with DSA results in good graft outcomes with a low rate of side effects. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
- Find related publications in this database (using NLM MeSH Indexing)
- Antibodies, Monoclonal - adverse effects
- Antibodies, Monoclonal - therapeutic use
- Antibodies, Monoclonal, Murine-Derived - adverse effects
- Antibodies, Monoclonal, Murine-Derived - therapeutic use
- Antilymphocyte Serum - therapeutic use
- Autoantibodies - blood
- Biomarkers - blood
- Blood Component Removal - adverse effects
- Blood Component Removal - methods
- Desensitization, Immunologic - adverse effects
- Desensitization, Immunologic - methods
- Enzyme-Linked Immunosorbent Assay -
- Graft Rejection - blood
- Graft Rejection - immunology
- Graft Rejection - prevention & control
- Graft Survival - drug effects
- HLA Antigens - immunology
- Histocompatibility -
- Histocompatibility Testing -
- Humans -
- Immunosorbent Techniques -
- Immunosorbents - therapeutic use
- Immunosuppressive Agents - adverse effects
- Immunosuppressive Agents - therapeutic use
- Kaplan-Meier Estimate -
- Kidney Transplantation - adverse effects
- Kidney Transplantation - immunology
- Living Donors -
- Plasmapheresis -
- Recombinant Fusion Proteins - adverse effects
- Recombinant Fusion Proteins - therapeutic use
- Rituximab -
- Time Factors -
- Treatment Outcome -
- Find related publications in this database (Keywords)
- Kidney transplantation
- Donor-specific antibodies
- Desensitization
- Immunoadsorption
- Rituximab
- Living donation