Publication:
Living donor kidney transplantation in patients with donor-specific HLA antibodies after desensitization with immunoadsorption

dc.contributor.coauthorKalble, Florian
dc.contributor.coauthorPego da Silva, Luiza
dc.contributor.coauthorSpeer, Claudius
dc.contributor.coauthorBenning, Louise
dc.contributor.coauthorNusshag, Christian
dc.contributor.coauthorPham, Lien
dc.contributor.coauthorTran, Hien
dc.contributor.coauthorSchaier, Matthias
dc.contributor.coauthorSommerer, Claudia
dc.contributor.coauthorBeimler, Jörg
dc.contributor.coauthorMehrabi, Arianeb
dc.contributor.coauthorZeier, Martin
dc.contributor.coauthorMorath, Christian
dc.contributor.departmentSchool of Medicine
dc.contributor.kuauthorSüsal, Caner
dc.contributor.schoolcollegeinstituteSCHOOL OF MEDICINE
dc.date.accessioned2024-11-09T12:03:16Z
dc.date.issued2021
dc.description.abstractDue to the current organ shortage, living donor kidney transplantation is increasingly performed across HLA (human leukocyte antigen) or ABO antibody barriers. There is still uncertainty about the risk of antibody-mediated rejection (AMR) episodes, which may limit long-term graft survival. From March 2007 to December 2016, 58 sensitized living donor kidney transplant candidates were identified and 38 patients eventually included in the study: 36 patients (95%) had pre-transplant and pre-desensitization Luminex-detected donor-specific HLA antibodies (DSA), and 17/36 patients (47%) in addition had a positive crossmatch result. Two patients had no detectable DSA but a positive CDC B-cell crossmatch result. Patients were treated with pre- and post-transplant apheresis and powerful immunosuppression including the anti-CD20 antibody rituximab (N = 36) in combination with thymoglobulin (N = 20) or anti-IL2 receptor antibody (N = 18). The results of the 38 successfully desensitized and transplanted patients were retrospectively compared to the results of 76 matched standard-risk recipients. Desensitized patients showed patient and graft survival rates similar to that of standard-risk recipients (P = 0.55 and P = 0.16, respectively). There was a trend toward reduced death-censored graft survival in desensitized patients (P = 0.053) which, however, disappeared when the 34 patients who were transplanted after introduction of sensitive Luminex testing were analyzed (P = 0.43). The incidence of rejection episodes without borderline changes were in desensitized patients with 21% similar to the 18% in standard-risk patients (P = 0.74). Thirty-six patients had pre-transplant HLA class I and/or II DSA that were reduced by 85 and 81%, respectively, during pre-transplant desensitization (P < 0.001 for both). On day 360 after transplantation, 20 of 36 (56%) patients had lost their DSA. The overall AMR rate was 6% in these patients, but as high as 60% in 5 (14%) patients with persistent and de novo DSA during year 1; 2 (40%) of whom lost their graft due to AMR. Eleven (31%) patients with persistent DSA but without de novo DSA had an AMR rate of 18% without graft loss while one patient lost her graft without signs of AMR. Our desensitization protocol for pre-sensitized living donor kidney transplant recipients with DSA resulted in good graft outcomes with side effects and rejection rates similar to that of standard-risk recipients. Adequate patient selection prior to transplantation and frequent immunological monitoring thereafter is critical to minimize rejection episodes and subsequent graft loss.
dc.description.fulltextYES
dc.description.indexedbyWOS
dc.description.indexedbyScopus
dc.description.indexedbyPubMed
dc.description.openaccessYES
dc.description.publisherscopeInternational
dc.description.sponsoredbyTubitakEuN/A
dc.description.sponsorshipDietmar Hopp Stiftung
dc.description.versionPublisher version
dc.description.volume8
dc.identifier.doi10.3389/fmed.2021.781491
dc.identifier.embargoNO
dc.identifier.filenameinventorynoIR03392
dc.identifier.issn2296-858X
dc.identifier.quartileQ2
dc.identifier.scopus2-s2.0-85122069090
dc.identifier.urihttps://hdl.handle.net/20.500.14288/1004
dc.identifier.wos738528100001
dc.keywordsDesensitization
dc.keywordsImmunoadsorption
dc.keywordsDonor-specific antibody (DSA)
dc.keywordsAntibody-mediated rejection (AMR)
dc.keywordsKidney transplantation
dc.language.isoeng
dc.publisherFrontiers
dc.relation.grantnoNA
dc.relation.ispartofFrontiers in Medicine
dc.relation.urihttp://cdm21054.contentdm.oclc.org/cdm/ref/collection/IR/id/10178
dc.subjectGeneral and internal medicine
dc.titleLiving donor kidney transplantation in patients with donor-specific HLA antibodies after desensitization with immunoadsorption
dc.typeJournal Article
dspace.entity.typePublication
local.contributor.kuauthorSüsal, Caner
local.publication.orgunit1SCHOOL OF MEDICINE
local.publication.orgunit2School of Medicine
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relation.isOrgUnitOfPublication.latestForDiscoveryd02929e1-2a70-44f0-ae17-7819f587bedd
relation.isParentOrgUnitOfPublication17f2dc8e-6e54-4fa8-b5e0-d6415123a93e
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