Saudi Journal of Kidney Diseases and Transplantation

ORIGINAL ARTICLE
Year
: 2011  |  Volume : 22  |  Issue : 4  |  Page : 662--669

Desensitization protocol for highly sensitized renal transplant patients: A single-center experience


Vivek B Kute1, Aruna V Vanikar2, Hargovind L Trivedi1, Pankaj R Shah1, Kamal R Goplani1, Himanshu V Patel1, Manoj R Gumber1, Rashmi D Patel2, Kamal V Kanodia2, Kamlesh S Suthar2, Varsha B Trivedi2, Pranjal R Modi3 
1 Department of Nephrology and Transplantation Medicine, IKDRC-ITS, Ahmedabad, India
2 Department of Pathology, Laboratory Medicine and Transfusion Services and Immunohematology, IKDRC-ITS, Ahmedabad, India
3 Department of Urology and Transplantation, IKDRC-ITS, Ahmedabad, India

Correspondence Address:
Vivek B Kute
Department of Nephrology and Clinical Transplantation, IKDRC-ITS, Ahmedabad
India

Highly sensitized patients are destined to remain untransplanted for long. Early transplantation results in cost-saving, reduced morbidity/mortality and improved quality of life. We carried out a prospective study to evaluate the efficacy and safety of desensitization protocol vis-à-vis patient/graft survival in living donor renal transplantation in highly sensitized patients. Between December 2008 and April 2010, 34 renal transplant (RTx) patients underwent desensitization protocol. An anti-human globulin-enhanced lymphocytotoxicity crossmatch assay (AHG-CDC) ≥25% and T-cell median channel shift (MCS) >50, B-cell MCS >100 [flow crossmatch (FXM)] were considered crossmatch (XM) positive. All patients were administered bortezomib (1.3 mg/m 2 , days 1, 4, 8, 11), plasmapheresis, rabbit-anti-thymocyte globulin (r-ATG), mycophenolate mofetil (MMF) and intravenous immunoglobulins (IVIg). LCXM and FXM were repeated post-protocol. In the event of persistent sensitization, additional bortezomib cycle was repeated along with plasmapheresis, IVIg, calcineurin inhibitors (CNI) and rituximab. If the cross match (CMX) was negative or acceptable, patients underwent RTx. Post-transplant immunosuppression consisted of prednisone, CNI and MMF. Biopsy was performed in the event of graft dysfunction and treated accordingly. There were 18 males and 16 females, with a mean age of 37.4 years. Mean dialysis duration was 14.9 ± 17.6 months. Average third party transfusions were 6.2 ± 4.5, 17.6% had autoimmune diseases, 20.6% were multi-para. Pre-protocol AHGXM was 55.3 ± 24.5%, T-cell crossmatch (TCXM) was 122.4 ± 91.4 MCS and B-cell crossmatch (BCXM) was 279 ± 142.9 MCS. Totally, 85.3% responded within 1 month with reduction in AHG-CDC to 19.9 ± 5.2%, TCXM to 24.7 ± 19.4 MCS and BCXM to 74.7 ± 34.8 MCS. Side effects noted in 38.2% were manageable. Over follow-up of 0.92 ± 0.8 years, patient/graft survival was 100%/88.2% and mean serum creatinine was 1.27 ± 0.32 mg/dL. Acute rejections were noted in 24.1%, who responded to steroids + rabbit antithymocyte globulin (rATG). Five (14.7%) patients were transplanted after changing donors. Our desensitization protocol seems to be safe and effective. Bortezomib may offer new possibilities in desensitization protocols.


How to cite this article:
Kute VB, Vanikar AV, Trivedi HL, Shah PR, Goplani KR, Patel HV, Gumber MR, Patel RD, Kanodia KV, Suthar KS, Trivedi VB, Modi PR. Desensitization protocol for highly sensitized renal transplant patients: A single-center experience.Saudi J Kidney Dis Transpl 2011;22:662-669


How to cite this URL:
Kute VB, Vanikar AV, Trivedi HL, Shah PR, Goplani KR, Patel HV, Gumber MR, Patel RD, Kanodia KV, Suthar KS, Trivedi VB, Modi PR. Desensitization protocol for highly sensitized renal transplant patients: A single-center experience. Saudi J Kidney Dis Transpl [serial online] 2011 [cited 2021 Apr 19 ];22:662-669
Available from: https://www.sjkdt.org/article.asp?issn=1319-2442;year=2011;volume=22;issue=4;spage=662;epage=669;aulast=Kute;type=0