Effect of desensitization treatment for highly sensitized uremic patients before kidney transplantation
10.3760/cma.j.issn.0254-1785.2011.08.005
- VernacularTitle:高致敏尿毒症患者肾移植术前的脱敏治疗及效果
- Author:
Xiaopeng YUAN
;
Changxi WANG
;
Wei GAO
;
Xiaoshun HE
- Publication Type:Journal Article
- Keywords:
Kidney transplantation;
PRA;
Desensitization,immunologic;
Plasma exchange;
Immunoglobulin
- From:
Chinese Journal of Organ Transplantation
2011;32(8):467-470
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the feasibility and efficacy of desensitization protocol for highly sensitized renal transplant patients (HSP). Methods Thirty-five HSPs ( HLA class-Ⅰ panel reactive antibody ＞50 %), including 27 patients with a positive T and/or B cell cytotoxicity crossmatch (XM) and 8 patients with a negative T and B cell XM, received plasmapheresis plus intravenous immunoglobulin (PP-IVIG)treatment. Results The positive XM was rendered negative by PP-IVIG treatment in 25 of 27 (92.6 %)HSPs, and subsequent transplantation was performed. Two patients did not receive renal transplants due to persistent positive XM. In 25 patients receiving renal transplants, no hyperacute rejection occurred. There were 8 cases of acute rejection, including 5 cases of acute humoral rejection (AHR). All rejection episodes were reversed. During a follow-up period of 52 ± 26 months, the serum creatinine levels at 12th and 24th month were 112± 18 and 130 ± 38 mol/L respectively. The 1- and 3-year graft survival rate was 96. 0 %and 80. 0 % respectively. Conclusion The desensitization therapy by PP-IVIG is effective for HSP. High rate of AHR is the major defect of this protocol. The short-term graft survival rate after this protocol is acceptable but the long-term survival rate needs to be defined.
