*Purpose: Patients with high titer of preexisting donor specific anti-HLA antibodies (DSA) have very high risk of antibody mediated rejection development and followed by the kidney graft loss. Standard methods of desensitization are non-specific, lead to increase in patients morbidity and mortality, and are expensive. We have assessed the effectiveness of donor specific desensitization by using of vascularized sentinel skin flap transplantation simultaneously with the kidney transplant.

*Methods: We performed a prospective randomized open study, which included 13 highly sensitized recipients of kidney allograft. The study group included 5 recipients. They all received vascularized sentinel skin flap transplantation simultaneously with the kidney transplant. The control group included 8 recipient of kidney graft only. Dynamics of the laboratory data, NGAL and MFI of anti-HLA antibodies was assessed at 1, 14, 30, 60 and 90 days after transplantation.

*Results: In the study group all skin grafts were removed because of vascular thrombosis at day 3 to 10 after transplantation. Dynamics of average MFI for DSA class A were in the range from 3239 (±7242,62) to 0,0 (±0,0) in the study group, and 2197 (±5528), 0,0 (±0,0) in the control group. Dynamics of average MFI for DSA class B were in the range from 3323 (±5029) to 0,0 (±0,0) in the study group, and from 1090 (±1572,4) to 675 (±1351,5) in the control group. Characteristics of average MFI for DSA class DRB1 at the control spots were in the range from 4324 (±3695,8) to 0,0 (±0,0) in the study group, and from 3014,5 (±3956,6) to 2727,8 (±3750,5) in the control group. Dynamics of MFI of DSA class DQB in the study group were in the range from 1959,8 (±3377,6) at 0 day to 0,0 (±0,0) at 90 day. Dynamics of MFI for DSA class DQB in the control group were in the range from 7841,25 (±8471,9) at 0 day to 12594,5 (±8715,8) at 90 day. Changes of MFI for DSA class DQA were from 4232,2 (±6854,4) to 0,0 (±0,0) in the study group, and from 6336,9 (±6832,9) to 11830 (±7956,63) in the control group.

*Conclusions: The results of our pilot study shows that using the vascularized sentinel skin flap for desensitization of kidney graft recipients is the new and effective option for decreasing titers of donor specific anti-HLA antibodies, especially antibodies to II class MHC antigens.

« Back to 2022 American Transplant Congress