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...
Gespeichert in:
| Hauptverfasser: | , , , , , , , , , , |
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| Dokumenttyp: | Article (Journal) |
| Sprache: | Englisch |
| Veröffentlicht: |
2010
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| 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 
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| 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 |
MARC
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| 245 | 1 | 3 | |a An integrative approach for the transplantation of high-risk sensitized patients |c Christian Morath, Jörg Beimler, Gerhard Opelz, Jörg Ovens, Sabine Scherer, Jan Schmidt, Bruno Schmied, Marie-Luise Gross, Vedat Schwenger, Martin Zeier, and Caner Süsal |
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| 520 | |a 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. | ||
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