Saudi Journal of Kidney Diseases and Transplantation

CASE REPORT
Year
: 2020  |  Volume : 31  |  Issue : 6  |  Page : 1432--1438

Successful desensitization and kidney transplantation in the presence of donor-specific anti-human leukocyte antigen antibodies in kidney transplant recipients


Muhammad Tassaduq Khan, Rashid bin Hamid, Sabahat Sarfaraz, Naranjan Lal, Jaleel Ahmed, Shobha Luxmi 
 Renal Transplant Unit, National Institute of Solid Organ and Tissue Transplantation, Dow University Hospital, Karachi, Pakistan

Correspondence Address:
Muhammad Tassaduq Khan
Renal Transplant Unit, National Institute of Solid Organ and Tissue Transplantation, Dow University Hospital, Karachi
Pakistan

Kidney transplantation has indisputably revamped renal medicine and restored hope among patients coming across fatal end-stage renal disease. However, sensitization of human leukocyte antigen (HLA) triggers extensive immunological fences to successful kidney transplantation and henceforth, transplant candidates are frequently demoted to the ever-growing waiting list owing to preformed donor specific antibodies (DSAs). Over the past few years, the advent of desensitization protocols has significantly overpowered the immunological barriers and enhanced the outcomes of kidney transplant recipients with DSAs against HLA. Those desensitization protocols include combination of plasmapheresis, high-dose intravenous immunoglobulin (IVIG), low-dose IVIG, rituximab, and/or bortezomib. These immunomodulatory treatments either eliminate DSAs or prevent their production. Lately, our transplant center developed and used a desensitization protocol (Two sessions of plasmapheresis on day 1 and 2 → injection rituximab on day 2 after plasmapheresis →no plasmapheresis on day 3 → eight sessions of plasmapheresis after day 3 and IVIG 100 mg/Kg/dose after each session of plasmapheresis → repeat HLA antibody detection test to confirm if DSAs are present against HLA with median fluorescence intensity (MFI)values <1000 and complement dependent cytotoxicity (CDC) crossmatch is negative for both T and B lymphocytes; if NO then continue plasmapheresis sessions with IVIG 100 mg/kg/dose till MFI values are <1000 and CDC crossmatch is negative for both T and B lymphocytes or if YES then proceed for transplantation → repeat dose of rituximab post-transplantation) to evaluate its effectiveness in improving kidney function in patients post-desensitization and kidney transplantation.


How to cite this article:
Khan MT, Hamid Rb, Sarfaraz S, Lal N, Ahmed J, Luxmi S. Successful desensitization and kidney transplantation in the presence of donor-specific anti-human leukocyte antigen antibodies in kidney transplant recipients.Saudi J Kidney Dis Transpl 2020;31:1432-1438


How to cite this URL:
Khan MT, Hamid Rb, Sarfaraz S, Lal N, Ahmed J, Luxmi S. Successful desensitization and kidney transplantation in the presence of donor-specific anti-human leukocyte antigen antibodies in kidney transplant recipients. Saudi J Kidney Dis Transpl [serial online] 2020 [cited 2021 Apr 20 ];31:1432-1438
Available from: https://www.sjkdt.org/article.asp?issn=1319-2442;year=2020;volume=31;issue=6;spage=1432;epage=1438;aulast=Khan;type=0