Highly sensitized (HS) patients (pts) seldom have chance to receive deceased donor kidney transplant (DDKT). A desensitization (DES) program including bortezomib was employed to facilitate DDKT in HS waitlisted pts.

We prospectively enrolled 19 pts. DES protocol consisted of IVIG (2g/kg, D0 and 30), rituximab (375 mg/m2, D1), and bortezomib (1.3mg/m2 on D14, 17, 21 and 24). Anti-HLA antibodies(Abs) were evaluated at baseline and at months 1, 2 and 5 after DES using single antigen Luminex assay. We compared transplant conversion rate and PRAs between DES and non-DES HS waitlisted pts (22 controls).

Mean age of DES group was 49.6±11.7 years old. Male to female ratio was 10:9. Baseline mean cPRA values were 82 ± 26%. Baseline mean class I and II MFI values were 1,837 ± 1,966 and 1,832 ± 1,048. Baseline peak class I and II MFI values were 12,875 ± 5,047 and 9,495 ± 7,201. After DES, KT were successfully performed in 6 pts (31.6%), compared to 4 (18.2%) pts among non-DES controls (p=0.017). Age and gender adjusted time varying covariate Cox analysis showed that DES increased the probability of receiving KT ( hazard ratio of 28.306 (95% C.I. 5.574 – 143.759)). However, neither cPRA values nor mean MFI values were changed. In the transplanted group, pre-DES donor specific antibody (DSA) levels were below 2,000 MFI in 5 of 6 pts, and DES decreased DSA level only in 1 patient from 9,860 to 7,125 MFI. DES did not significantly decrease flowcytometric crossmatch intensity. DES protocol was well tolerated without serious adverse event, and 94.7% pts completed the protocol. No acute rejection occurred in DES KT group, whereas it occurred in 2 patients (50%) in non-DES KT group.

DES including concomitant bortezomib and rituximab reduced neither cPRA nor mean MFI values. However, DES increased the probability of DDKT in HS waitlisted pts, and post-KT outcomes were good.

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