Outcome after Desensitization in HLA or ABO-Incompatible Kidney Transplant Recipients: A Single Center Experience

PLoS One. 2016 Jan 5;11(1):e0146075. doi: 10.1371/journal.pone.0146075. eCollection 2016.

Abstract

Background: The shortage of deceased donors led to an increase of living donor kidney (LDK) transplantations performed in the presence of donor-specific antibodies (DSA) or ABO incompatibility (ABOi) using various desensitization protocols.

Methods: We herein analyzed 26 ABOi and 8 Luminex positive DSA patients who were successfully desensitized by anti-CD20, antigen-specific immunoadsorption and/or plasmapheresis to receive an LDK transplant. Twenty LDK recipients with non-donor-specific HLA-antibodies (low risk) and 32 without anti-HLA antibodies (no risk) served as control groups.

Results: 1-year graft survival rate and renal function was similar in all 4 groups (creatinine: 1.63 ± 0.5 vs 1.78 ± 0.6 vs 1.64 ± 0.5 vs 1.6 ± 0.3 mg/dl in ABOi, DSA, low risk and no risk group). The incidence of acute T-cell mediated rejections did not differ between the 4 groups (15% vs 12, 5% vs 15% vs 22% in ABOi, DSA, low risk and no risk), while antibody-mediated rejections were only found in the DSA (25%) and ABOi (7.5%) groups. Incidence of BK nephropathy (BKVN) was significantly more frequent after desensitization as compared to controls (5/34 vs 0/52, p = 0.03).

Conclusion: We demonstrate favorable short-term allograft outcome in LDK transplant recipients after desensitization. However, the desensitization was associated with an increased risk of BKVN.

MeSH terms

  • ABO Blood-Group System / immunology*
  • Adult
  • BK Virus / immunology
  • BK Virus / isolation & purification
  • Blood Group Incompatibility / complications
  • Blood Group Incompatibility / immunology*
  • Desensitization, Immunologic* / adverse effects
  • Desensitization, Immunologic* / methods
  • Female
  • Graft Rejection / etiology
  • Graft Rejection / immunology
  • Graft Survival
  • HLA Antigens / immunology*
  • Humans
  • Kidney / immunology
  • Kidney / virology
  • Kidney Transplantation* / adverse effects
  • Kidney Transplantation* / methods
  • Living Donors
  • Male
  • Middle Aged
  • Polyomavirus Infections / etiology
  • Polyomavirus Infections / immunology
  • Retrospective Studies
  • Transplant Recipients

Substances

  • ABO Blood-Group System
  • HLA Antigens

Grant support

The authors have no support or funding to report.