Session Name: Kidney Immunosuppression: Desensitization
Session Date & Time: None. Available on demand.
*Purpose: Transplantation across a positive flow crossmatch (+FXM) has been established as a lifesaving measure in the living donor setting. Time required for desensitization limits utility in deceased donor transplants (DDTx). We report outcomes of +FXM DDTx recipients using conventional and modified desensitization applied in the postoperative setting.
*Methods: Adult +FXM DDTx recipients from 7/2018 to 6/2020 were analyzed. Crossmatch was done by local HLA lab or organ procurement organization. No patients received waitlist desensitization. Standard of care was Plasmapheresis(PP)/Thymoglobulin 2.5mg/kg (IBW) on POD0,1,3,5,7,9 and IVIG 150mg/kg (IBW) on POD2,4,6,8. A subset of patients received PP/bortezomib 1.3mg/m2 on POD1,4,8,11 and Thymoglobulin 1.5mg/kg (IBW) on POD0-4. Discharge IS consisted of TAC, MPA, and prednisone.
*Results: Twenty six patients received +FXM DDTx. All had negative standard XM. Majority (92.3%) received isolated kidney, were female (57.7%) and black (46.1%). Table 1 details demographic and IS. T cell +FXM was present in 73.1% cases, and B cell +FXM in 80.8% cases. Patient outcomes are provided in Table2. Three patients (11.5%) experienced delayed graft function. Four patients (16%) received rejection treatment (1/BPAR requiring IVIG/PP/Thymoglobulin; and 3/with steroids). At 6 months, mean eGFR was 57+/- 34.9 ml/min. Patients with longer follow up showed stable eGFR out to 24 months (Figure 1). Majority (69.2%) remained on TAC/MPA/Pred at last follow up. Seven patients (27%) required IS manipulation (4 for infection [57.2%] and 2 for leucopenia [28.6%]). Two patients died, both due to infection related complications; neither experienced rejection. Serial DSA screening was performed in 92.3% cases, with 54% showing negative Class I and 75% showing negative Class II DSA at last follow up, Table 3. Majority of patients had a decline in both Class I (72.7%) and Class II (54.5%) DSA strength index at last follow up.
*Conclusions: Decreased donor transplantation across +FXM may be an option for a select group of patients but requires close monitoring and swift IS modification to ensure optimal outcomes.
To cite this abstract in AMA style:Campara M, Lichvar A, Benken J, Patel S, Muran C, Pierce D, Tang I, Cocco PDi, Alvarez JAlmario, Spaggiari M, Benedetti E, Tzvetanov I. Deceased Donor Transplantation Across Positive Flow Crossmatch – A Single Center Experience [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/deceased-donor-transplantation-across-positive-flow-crossmatch-a-single-center-experience/. Accessed June 13, 2021.
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