Desensitisation of highly immunised kidney transplant recipients awaiting transplantation – Polish single-centre experience

Abstract

IntroductionThe increasing number of highly immunised patients waiting for kidney transplantation is a significant problem in Europe as the proportion of such patients has doubled in the last decade. Transplantation in this group is enabled by desensitisation methods i.e. intravenous pharmacotherapy with human immunoglobulin (IVIG), anti-CD20 monoclonal antibody (rituximab) and plasma exchange. The objective was to evaluate the efficacy and safety of this protocol. Material and methodsThe inclusion criteria: presence of established anti-HLA antibodies with complement-binding capacity, i.e. anti-HLAC1q+ (>MFI 15000 for the most common antigens), no renal transplantation within 1 year after activation on the waiting list. 13 patients were selected for the procedure. IVIG was administered twice (2g/kg-maximum 140g/dose). Between IVIG doses, patients received rituximab (375mg/m2). Anti-HLA were tested after one and two months after completion of the procedure. ResultsAll patients have completed the protocol. No significant change after desensitisation in the amount/profile of alloantibodies were observed. However, with negative vCM for HLA-A/B/DR (no DSA against the reported donor) and negative CM-CDC, according to the allocation system, patients were given priority on the recipient list. 7 out of 13 patients received a transplant within 12 months after treatment (mean-11.5 weeks). Renal graft function was good (mean creatinine level after 1 month: 1.5mg/dl). No incidents of acute rejection were reported. The most common complications were infections (especially pneumonia). ConclusionThe desensitisation protocol (IVIG+rituximab) allows highly immunised patients to undergo organ transplantation. In short-term analysis, no acute rejection was observed, graft function was satisfactory. Desensitisation was associated with an increased risk of infection.