Introduction: Many kidney-transplant (KT) candidates are sensitized against HLA-antigens, making it difficult to find a suitable HLA-compatible donor. Pretransplant HLA-desensitization strategies have shown improved patient survival after transplantation.

Purpose: This single-centre study included 15 KT candidates (of which seven had a potential living-donor) that underwent kidney transplantation after desensitization comprising two rituximab injections (375 mg/m[sup2]) with concomitant immunosuppression [tacrolimus + mycophenolic acid + steroids, and semi-specific immunoadsorption (IA) (Globaffin[Ograve] columns)]. IA sessions were performed until anti-HLA alloantibodies become ≤3,000 mean fluorescent intensity (MFI). At transplantation, all patients were induced with ATG. On average, recipients of a living-kidney had 13 (9-16) pretransplant IA sessions;at transplant their donor-specific alloantibodies (DSA) had MFI of ≤3,000 with no rebound at posttransplant. Recipients of deceased donors had 22 (11-93) pretransplant IA sessions; most of them had a DSA at transplantation; however, MFI was ≤3,000 in all cases but one (anti-DP2 at 10,000). After transplantation, there was no prophylactic IA therapy in both groups. No living-kidney recipients and two deceased-donor recipients had antibody-mediated rejections (ABMR), which were treated with eculizumab: one treatment was successful; the other patient lost the graft. Follow-up kidney biopsies (at a median of 12 months posttransplantation) were normal except for two cases in which there were signs of subclinical ABMR. There was no significant infectious complications.

Conclusion: Semi-specific immunoadsorption was very effective at achieving HLA desensitization.

CITATION INFORMATION: Malvezzi P., Jouve T., Masson D., Maurizi J., Bardy B., Carron P-.L., Janbon B., Terrier N., Rostaing L. HLA Desensitization Using Rituximab/ Immunoadsorption before Kidney Transplantation Am J Transplant. 2017;17 (suppl 3).

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