46-P

Abstract

Aim Until recently, living donor kidney transplantation was not performed in case of a positive crossmatch due to the presence of donor specific HLA antibodies in historical serum. Furthermore, patients with anti-donor HLA antibodies present in current sera as detected by Luminex-based solid-phase assays will often not be transplanted with such a donor without desensitization. Methods Between February 2010 and July 2011, 6 immunized renal transplant candidates with a positive crossmatch against their living donor, were transplanted without any desensitization. These patients received standard immunosuppressive therapy, which consisted of a combination of tacrolimus, mycophenolate, corticosteroids, and basiliximab. Results In 5 patients (CDC reactive) antibodies were found against the HLA mismatch of their living donor in historical sera. Current en historical panel reactive antibody level of these patients were respectively: cur 4% his 82%, cur 0% his 100%, cur 0% his 96%, cur 4% his 65% and cur 0% his 94%. The HLA mismatches were HLA-A1, -A2 (2x), -A3 and HLA-DR3. In 4 of the 5 patients this HLA mismatch was a repeated mismatch. In 2 of the 5 patients with historical CDC reactive antibodies against the repeated mismatch the Luminex assays in current sera was (weakly) positive. In a 6th patient, the current serum was strongly positive in the Luminex assay for the HLA-DR9 mismatch (PRA cur 33 % his 56%). Three of these 6 patients experienced a rejection but until now (follow up: 7-20 months) all these transplants are functioning well. Conclusions Our conclusion is that a positive CDC crossmatch in historical sera is not a contra-indication for kidney transplantation not even in the presence of donor specific antibodies detected in current serum by Luminex-based solid-phase assays.