This study examined the mid-term clinical outcomes in positive crossmatch kidney transplants (XMKT) for patients who received desensitization with plasmapheresis (PP) and anti-CD20 based regimens without intravenous immunoglobulin (IVIG).

After excluding seven patients who were treated with IVIG preoperatively, 1,641 consecutive patients who underwent living donor KT between January 2009 and July 2016 were included. In subgroup analysis, 834 of the patients were categorized into three groups according to pre-transplant anti-human leukocyte antigen (HLA) antibody status: HLA compatible (676 patients), Luminex-only positive (LP) (105 patients), and positive XM (XP) (53 patients). The XP group consisted of 22 complement-dependent cytotoxicity (CDC) and 33flow-cytometric crossmatch (FCXM) positive patients.

Kaplan–Meier analysis showed thatpatients in the HLA-compatible group had significantly increased overall patient survival compared to the XP group (P = 0.021). Although the overall graft survival (GS), death-censored GS, and rejection-free GS showed no significant differences between the compatible and FCXM positive groups, the CDC positive group showed inferior outcomes among the three groups for GS, death-censored GS, and rejection-free GS (P < 0.001). On subgroup analysis to determine the factors associated with acute rejection, only class II DSA MFI ≥5000 was a significant risk factor (hazard ratio: 2.20; P =0.04).

This study suggests that positive XMKT who were treated with PP and anti-CD20-based regimens without IVIG showed comparable outcomes. Preformed DSA is a prominent risk factor for acute rejection following kidney transplantation, particularly for patients with class II DSA MFI >5000.

CITATION INFORMATION: Kwon H., KIm Y., Choi J., Shin S., Jung J., Cho M., Kim J., Han D. The Results of Plasmapheresis and Anti-CD20 Based Desensitization without Intravenous Immunoglobulin in Positive Crossmatch Kidney Transplants Am J Transplant. 2017;17 (suppl 3).

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