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An integrative approach for the transplantation of high-risk sensitized patients

Background. - Sensitized patients have a lower chance of receiving a crossmatch-negative kidney and, if transplanted, are at risk of antibody-mediated allograft rejection. - Methods. - For safe and timely transplantation of sensitized patients at our center, we develo...

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Bibliographische Detailangaben
Hauptverfasser: Morath, Christian (VerfasserIn) , Beimler, Jörg (VerfasserIn) , Opelz, Gerhard (VerfasserIn) , Ovens, Jörg (VerfasserIn) , Scherer, Sabine (VerfasserIn) , Schmidt, Jan (VerfasserIn) , Schmied, Bruno (VerfasserIn) , Groß-Weissmann, Marie-Luise (VerfasserIn) , Schwenger, Vedat (VerfasserIn) , Zeier, Martin (VerfasserIn) , Süsal, Caner (VerfasserIn)
Dokumenttyp: Article (Journal)
Sprache:Englisch
Veröffentlicht: 2010
In: Transplantation
Year: 2010, Jahrgang: 90, Heft: 6, Pages: 645-653
ISSN:1534-6080
DOI:10.1097/TP.0b013e3181ea3985
Online-Zugang:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1097/TP.0b013e3181ea3985
Verlag, lizenzpflichtig, Volltext: https://journals.lww.com/transplantjournal/Fulltext/2010/09270/An_Integrative_Approach_for_the_Transplantation_of.8.aspx
Volltext
Verfasserangaben:Christian Morath, Jörg Beimler, Gerhard Opelz, Jörg Ovens, Sabine Scherer, Jan Schmidt, Bruno Schmied, Marie-Luise Gross, Vedat Schwenger, Martin Zeier, and Caner Süsal
Beschreibung
Zusammenfassung:Background. - Sensitized patients have a lower chance of receiving a crossmatch-negative kidney and, if transplanted, are at risk of antibody-mediated allograft rejection. - Methods. - For safe and timely transplantation of sensitized patients at our center, we developed an integrative algorithm that includes identification of high-risk patients, good human leukocyte antigen match, inclusion in the Eurotransplant Acceptable Mismatch Program when applicable, apheresis, anti-CD20 therapy, posttransplant antibody monitoring, and protocol biopsies. Thirty-four high-risk recipients of a deceased donor kidney (DDK: n=28) or living donor kidney (LDK: n=6) were transplanted using this algorithm. - Results. - One-year graft survival, death-censored graft survival, and patient survival rates in DDK recipients were 92.4%, 96.4%, and 95.8%, respectively. No graft loss or patient death was observed in the six LDK patients. Median serum creatinine at 1 year in DDK and LDK recipients was 1.2 and 1.4 mg/dL, respectively. Eleven DDK and three LDK patients experienced at least one biopsy-proven acute rejection episode, mostly showing borderline changes. Antibody-mediated rejection without graft loss was diagnosed in two DDK and one LDK patients. Delayed graft function was observed in 13 DDK and 1 LDK patients. Infectious complications were infrequent. - Conclusions. - We describe an algorithm for the categorization and treatment of presensitized high-risk patients. This protocol provides effective prevention of antibody-mediated rejection and is associated with a low rate of side effects and good graft outcome.
Beschreibung:Gesehen am 04.05.2023
Beschreibung:Online Resource
ISSN:1534-6080
DOI:10.1097/TP.0b013e3181ea3985

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