Renal transplantation in patients with positive lymphocytotoxicity crossmatches: one center's experience

Transplantation. 2008 Jul 15;86(1):96-103. doi: 10.1097/TP.0b013e318176ae2c.


Background: Sensitization to human leukocyte antigens remains an important barrier to successful renal transplantation.

Materials and methods: Herein we describe our center's experience with a plasmapheresis-based desensitization protocol for highly sensitized patients. Twenty-nine patients had a positive T-cell or positive B-cell lymphocytotoxicity crossmatch against their donors. In some cases, baseline crossmatches were of high titer (e.g., 11 had baseline titers > or =1:32).

Results: Twenty-eight of 29 patients were rendered T-cell crossmatch negative and B-cell crossmatch negative/low positive and transplanted. None had hyperacute rejection but 11 (39%) had acute antibody mediated rejection. Median follow-up is 22 months: 25 of the 28 (89%) of allografts are still functioning with mean plasma creatinine 1.5 mg/dL. There was one death because of the transplant or immunsuppression, one case of cytomegalovirus disease and no cases of lymphoproliferative disease.

Conclusion: This series provides further evidence of the high efficacy of plasmapheresis-based desensitization protocols. Even patients with high baseline crossmatch titers can be successfully desensitized and transplanted. Short- and medium-term outcomes are encouraging but longer-term data are needed.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Aged
  • Antibody Formation*
  • Cytotoxicity, Immunologic*
  • Desensitization, Immunologic / methods*
  • Female
  • Graft Rejection / immunology
  • Graft Rejection / prevention & control*
  • Graft Survival
  • HLA Antigens / analysis
  • Histocompatibility Testing*
  • Humans
  • Immunoglobulins, Intravenous / therapeutic use
  • Immunosuppressive Agents / therapeutic use
  • Kidney Failure, Chronic / immunology
  • Kidney Failure, Chronic / surgery
  • Kidney Failure, Chronic / therapy*
  • Kidney Transplantation / immunology*
  • Lymphocytes / immunology*
  • Male
  • Middle Aged
  • Plasmapheresis*
  • Time Factors
  • Treatment Outcome


  • HLA Antigens
  • Immunoglobulins, Intravenous
  • Immunosuppressive Agents