Date: Sunday, June 2, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: HLA sensitization is a barrier for kidney transplantation. Sensitized patients stay longer on the waiting list and have higher mortality rate and complications while waiting for a transplant. Various DS procedures have shown to increase transplant access and provide good patient and graft survival. Here we present our results using only IVIG for DS.
*Methods: A retrospective study was carried out, in which records of 45 patients, evaluated from January 2003 to December 2014, were analyzed. Patients with a LD against whom they presented a positive CDC or FCXM, received monthly 2g/Kg IVIG infusions until negativation of the T and B-FCXM.
*Results: Of the 45 patients, 12 were excluded (1 patient died prior to the onset of DS, 4 patients abandoned, 4 patients changed from transplant center, a donor has given up the transplant, 1 patient underwent transplantation with protocol including plasmapheresis and Rituximab and 1 patient obtained an identical donor). After sixty months of follow-up, 22 patients underwent renal transplantation with a LD, 7 underwent transplantation with a deceased donor (analyzed elsewhere) and 4 did not get to be transplanted. The patients were on dialysis for 86.62 ± 60.28 months and had a mean Class I PRA of 73.90±22.29% and class II of 66.27±35.67. Sixteen (81,81%) patients presented a positive T and/or B-CDCXM; while 4(18.19%) patients presented a positive T and/or B-FCXM. The patients underwent transplantation after a mean of 6 ± 3 IVIG infusions. The MFI-DSA before DS was 5057 (2246-11691). After desensitization, the MFI-DSA was 1389 (934-2492) (p <0,0001). Transplants were performed with Thymoglobulin, IVIG, tacrolimus, sodium mycophenolate and prednisone and a protocol biopsy was performed on seventh day after transplantation. Eight patients (40%) showed T cell-mediated rejections, and 6 patients (27.27%) presented ABMR (treated with apheresis, Rituximab and IVIG). After 1,3 and 5 years, patient survival was 95,5%, 95,5%, 85% and death-censored graft survival was respectively 90.5%, 90.5% and 82.3%. Mean 1, 3 and 5-year creatinine clearance (MDRD) was 66.21±14.24; 60.39±21.19 and 60.59±22.80 ml/min/1.73m2. No severe adverse events due to the use of IVIG were observed.
*Conclusions: DS using only IVIG showed to be a very safe and effective strategy (transplant rate=87.87%) to provide renal transplantation for highly-sensitized patients who presented with a positive crossmatch living donor.
To cite this abstract in AMA style:Ulisses LR, Paixão JO, Souza PS, Bezerra G, Rodrigues H, Panajatopoulos N, Paula FJDe, David-Neto E, Castro MCR. Desensitization Using Only Polyvalent Immunoglobulins (IVIG) for Kidney Transplantation with Living Donors (LD) [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/desensitization-using-only-polyvalent-immunoglobulins-ivig-for-kidney-transplantation-with-living-donors-ld/. Accessed May 9, 2021.
« Back to 2019 American Transplant Congress