Outcomes in Preformed Donor-Specific Human Leukocyte Antibody Positive Living Kidney Transplant Recipients Desensitized with Intravenous Immunoglobulin and Rituximab

Y. kakuta¹, M. Okumi¹, T. Kanzawa¹, K. Unagami², H. Ishida², K. Tanabe¹

¹Urology, Tokyo Women's Medical University, Tokyo, Japan, ²Organ Transplant Medicine, Tokyo Women's Medical University, Tokyo, Japan

Meeting: 2019 American Transplant Congress

Abstract number: B179

Keywords: Highly-sensitized, HLA antibodies, Kidney transplantation

Session Information

Session Name: Poster Session B: Kidney Immunosuppression: Desensitization

Session Type: Poster Session

Date: Sunday, June 2, 2019

Session Time: 6:00pm-7:00pm

Presentation Time: 6:00pm-7:00pm

Location: Hall C & D

*Purpose: Donor-specific antibody (DSA) is associated with antibody-mediated rejection (ABMR) and is a significant immunologic barrier to graft and patient survival. Pre-transplant desensitization therapy has been developed by various institutions to prevent ABMR. We report our outcome data emphasizing a risk-stratified desensitization protocol for DSA-positive living kidney transplantation (LKT).

*Methods: We performed a retrospective, observational study of 422 patients who underwent LKT in our institution. The patients were stratified into three immunological risk groups as follows: XM+DSA+ (n=22), XM-DSA+ (n=51), and XM-DSA- (n=349). Patients in the XM+DSA+ group received 2-4 g/kg of intravenous immunoglobulin (IVIG) and rituximab combined with plasmapheresis before LKT. The XM-DSA+ group received rituximab combined with plasmapheresis.

*Results: The 5-year patient survival rates were 98.6%, 96.1%, and 95.5% in the XM-DSA-, XM-DSA+, and XM+DSA+ groups, respectively (p=0.431). The 5-year graft survival (non-censored for death) rates were 96.6%, 94.1%, and 86.4%, respectively, and the 5-year death-censored graft failure rates were 98.0%, 98.0%, and 90.9% in the XM-DSA-, XM-DSA+, and XM+DSA+ groups, respectively (p = 0.104). The XM+DSA+ group had lower graft survival, but with no significant difference (p = 0.08). Biopsy-proven acute ABMR rates within 90 days post-transplantation were 6.3% in the XM-DSA- group, 21.6% in the XM-DSA+ group, and 54.5% in the XM+DSA+ group. The XM+DSA+ group had a lower estimated glomerular filtration rate, but there was no significant difference in proteinuria incidence among the three groups 5 years post-transplantation. There were no significant differences in the incidence of each infectious complication, including pneumonia, urinary tract infection, cytomegalovirus, BK virus, and adenovirus infection between the three groups.

*Conclusions: In terms of patient and graft survival rates and graft function, there were no significant differences between DSA-positive and DSA-negative LKT. However, the occurrence of ABMR was significantly higher in the DSA-positive group despite our strict desensitization protocol.

To cite this abstract in AMA style:

kakuta Y, Okumi M, Kanzawa T, Unagami K, Ishida H, Tanabe K. Outcomes in Preformed Donor-Specific Human Leukocyte Antibody Positive Living Kidney Transplant Recipients Desensitized with Intravenous Immunoglobulin and Rituximab [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/outcomes-in-preformed-donor-specific-human-leukocyte-antibody-positive-living-kidney-transplant-recipients-desensitized-with-intravenous-immunoglobulin-and-rituximab/. Accessed May 8, 2025.

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