The effect of desensitization therapy in kidney transplantation

Clin Exp Nephrol. 2018 Feb;22(1):179-187. doi: 10.1007/s10157-017-1424-7. Epub 2017 Jun 20.

Abstract

Background: Desensitization therapy may enable the patient to get allograft in sensitized recipient or solve the organ shortage in ABO-incompatible relationship in kidney transplantation (KT). However, the graft outcome and morbidity remains unclear.

Methods: We retrospectively analyzed 845 KT patients from January 2010 to February 2016 at Seoul National University Hospital. The patients were divided into three groups as follows: HLA-incompatible (HLAi) group, ABO-incompatible (ABOi) group, and control group. The HLAi group comprised patients who received desensitization therapy due to the presence of donor-specific antibodies (DSAs) or high panel reactive antibodies (PRAs). The ABOi group is defined as those undergoing preoperative desensitization therapy for anti-ABO antibodies.

Results: Of the total of 845 recipients, 48 (5.6%) were HLAi KTs and 71 (13.9%) were ABOi KTs, respectively. Pre-emptive KT is done more frequently in ABOi group, therefore, they had shorter dialysis duration than the others. HLAi recipients had a higher proportion of women than the ABOi group and a higher proportion of re-transplantation. During the 38.4 (0.4-76.9) months of follow-up, there were more acute antibody-mediated rejections (AAMRs) in the HLAi (6.7%) and ABOi (8.5%) groups than in the control group (1.9%) (P = 0.001). However, there was no difference in graft survival, patient survival, and annual allograft among three groups.

Conclusions: Despite the higher incidence of AAMRs, HLAi and ABOi KTs showed a favorable graft and patient outcome after desensitization therapy.

Keywords: ABO-incompatibility; Desensitization; HLA-incompatibility; Kidney transplantation.

MeSH terms

  • ABO Blood-Group System
  • Adolescent
  • Adult
  • Aged
  • Desensitization, Immunologic*
  • Female
  • Follow-Up Studies
  • Graft Rejection / epidemiology
  • Graft Survival
  • HLA Antigens
  • Humans
  • Immunosuppression
  • Kidney Neoplasms / epidemiology
  • Kidney Transplantation / methods*
  • Male
  • Middle Aged
  • Postoperative Complications / epidemiology
  • Retrospective Studies
  • Surgical Wound Infection / epidemiology
  • Treatment Outcome
  • Young Adult

Substances

  • ABO Blood-Group System
  • HLA Antigens