Renal transplantation in highly sensitized patients represents a major clinical challenge leading to long periods in the waiting list. When a living donor is available, the use of different strategies to desensitize recipients with preformed human leukocyte antigen antibodies can allow for a successful transplantation.

Methods

We performed a retrospective observational study including all living donor kidney transplantation (LDKT) with desensitization (DS) from 2008 to 2014 in our transplant unit. Rate of rejection and graft survival was evaluated. DS consisted in plasma exchange(PE), rituximab (RTX) and intravenous immunoglobulin (IVIg). Induction with thymoglobulin and maintenance inmunosupression with tacrolimus, corticosteroids and mycophenolate mofetil.

Results

From 2008 to 2014, we performed 368 LDKT, 31 receiving DS. Seven cases from a clinical trial were excluded. Demographical data and outcomes were recorded. All of the patients received RTX + PE + IVIg. DS was performed due to positive complement dependent cytotoxicity crossmatch (4.2%), positive flow cytometry crossmatch (87.5%) and presence of donor specific antibodies (8.3%). We identify 23 episodes of rejection (AMR) in 12 patients (50%), 79% were antibody mediated rejections. Graft failure was 12.5%, with a mean time to graft loss of 229 ± 203 days. Mean follow-up was 37 ± 27 months, and graft survival was 91% and 86% at 1 and 5 years respectively.

Conclusions

Desensitization in LDKT seems to offer an acceptable option for highly sensitized patients. In our series, 50% presented an AMR and 12.5% showed transplant glomerulopathy in protocol and/or indication biopsies. However, short-term outcomes and graft survival were satisfactory.

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