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Living donor kidney transplantation in crossmatch-positive patients enabled by peritransplant immunoadsorption and anti-CD20 therapy

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Living donor kidney transplantation in crossmatch-positive patients is a challenge that requires specific measures. Ten patients with positive crossmatch results (n = 9) or negative crossmatch results but strong donor-specific antibodies (DSA; n = 1) were desensitized using immunoadsorption (IA) and...

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Main Authors: Morath, Christian (Author) , Zeier, Martin (Author) , Süsal, Caner (Author) , Beimler, Jörg (Author) , Opelz, Gerhard (Author) , Scherer, Sabine (Author) , Schmidt, Jan (Author) , Macher-Göppinger, Stephan (Author) , Klein, Katrin (Author) , Sommerer, Claudia (Author) , Schwenger, Vedat (Author)
Format: Article (Journal)
Language:English
Published: 29 February 2012
In: Transplant international
Year: 2012, Volume: 25, Issue: 5, Pages: 506-517
ISSN:1432-2277
DOI:10.1111/j.1432-2277.2012.01447.x
Online Access:Verlag, kostenfrei, Volltext: http://dx.doi.org/10.1111/j.1432-2277.2012.01447.x
Verlag, kostenfrei, Volltext: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1432-2277.2012.01447.x
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Author Notes:Christian Morath; Jörg Beimler; Gerhard Opelz; Sabine Scherer; Jan Schmidt; Stephan Macher-Goeppinger; Katrin Klein; Claudia Sommerer; Vedat Schwenger; Martin Zeier; Caner Süsal
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Summary:Living donor kidney transplantation in crossmatch-positive patients is a challenge that requires specific measures. Ten patients with positive crossmatch results (n = 9) or negative crossmatch results but strong donor-specific antibodies (DSA; n = 1) were desensitized using immunoadsorption (IA) and anti-CD20 antibody induction. IA was continued after transplantation and accompanied by HLA antibody monitoring and protocol biopsies. After a median of 10 IA treatments, all patients were desensitized successfully and transplanted. Median levels of mean fluorescence intensity (MFI) of Luminex-DSA before desensitization were 6203 and decreased after desensitization and immediately before transplantation to 891. Patients received a median of seven post-transplant IA treatments. At last visit, after a median follow-up of 19 months, 9 of 10 patients had a functioning allograft and a median Luminex-DSA of 149 MFI; serum creatinine was 1.6 mg/dl, and protein to creatinine ratio 0.1. Reversible acute antibody-mediated rejection was diagnosed in three patients. One allograft was lost after the second post-transplant year in a patient with catastrophic antiphospholipid syndrome. We describe a treatment algorithm for desensitization of living donor kidney transplant recipients that allows the rapid elimination of DSA with a low rate of side effects and results in good graft outcome.
Item Description:Gesehen am 07.05.2018
Physical Description:Online Resource
ISSN:1432-2277
DOI:10.1111/j.1432-2277.2012.01447.x

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