Date: Sunday, June 2, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: The reduction of anti-HLA has been proven to be efficient and safe in transplants of highly-sensitized with living donors (LD). The results of adopting only IVIG to increase access to deceased donor (DD) transplants in these patients are shown here.
*Methods: Retrospective analysis of highly-sensitized patients enrolled for kidney transplantation with a DD, presenting many positive T or B-cell CDC-XM on the waiting list (WL) and who underwent a desensitization (DS) protocol using IVIg 2g/kg/month, from Jan/03-Dec/13, and followed over 56,18 months (±20,57). Transplants were cleared with the first donor presenting a negative T and B-cell CDC-XM.
*Results: Of the 45 patients evaluated, 6 were excluded (3 obtained a LD and 3 did not complete the minimum of 3 IVIG doses). Of the remaining 39 patients, 14 (35.9%) were transplanted during the follow-up time (FUT), 9 (64.3%) presenting A, B or DR donor specific ab (DSA). For these patients, mean time on the WL before DS was 75±41 months and after DS, 20±11 months (p<0,01). Patients who were given priority on the WL, due to problems on vascular access for dialysis, presented higher transplantation rates: 70% vs 21% (p=0.002). IVIg therapy resulted in a decrease in class I (78.4±26 vs. 69.5±31, p=0.007) and class II PRA (74.36±27.50 vs. 61.79±36.26, p=0.04). There was a significant decrease in the number of anti-HLA antibodies (ab) before and after DS: on MFI levels up to 1500 (11±4 to 3±2, p=0.0002) and between 5000 and 10000 (17±3 to 14±4, p=0.004). Patients transplanted received 7±4 IVIg doses. During the DS process, there was a significant reduction in the immune dominant DSA (iDSA) of those transplanted with a specific ab (3615±1514 vs. 2020±1299, p=0.03). Mean FUT after transplantation was 18.18±16.67 months. After 24 months, patient survival was 92.87% and death-censored graft survival was 96%. ABMR rate was 35.71% and all episodes occurred in patients presenting more than 1 DSA. Renal function (MDRD) in 24 months was not different in patients with and without rejection (36.1 vs. 56.8, p=0.20). No serious side effects related to IV infusions were observed.
*Conclusions: DS using only IVIG has been shown to be effective and safe in reducing the waiting time for DD kidney transplantation in highly-sensitized patients.
To cite this abstract in AMA style:Paixão JO, Ulisses LR, Souza PS, Bezerra G, Agena F, Rodrgues HP, Panajotopoulos N, Paula FJ, David-Neto E, Castro MR. Desensitization Using Only IVIG: Is That an Option for Highly-Sensitized Patients Waiting for Kidneys from Cadaveric Donors? [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/desensitization-using-only-ivig-is-that-an-option-for-highly-sensitized-patients-waiting-for-kidneys-from-cadaveric-donors/. Accessed July 10, 2020.
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