Desensitization Protocol Consisted of DFPP, Anti-CD20 Ab, Tacrolimus and Mycofenolate Mofetil, Improves Graft Function in Sensitized Patients of Living-Donor Kidney Transplantaion.

Abstract

Objective) The aim of this study was to investigate the efficacy of desensitization protocol (DP) including double filtration plasmapheresis (DFPP), rituximab, tacrolimus (Tac), and mycofenolate mofetil (MMF), and to evaluate risk factors for graft function in sensitized patients of living-donor kidney transplantation (LDKT). Methods) Retrospectively, 35 recipients of LDKT, who had preformed donor-specific HLA antibodies (DSA), with average age of 51.0±13.0 (13 males and 22 females), were included in the study. Recipients were divided into 2 groups, Group 1 (n=9): DP consisted of DFPP and/or a rituximab (100mg) at four days before transplantation, and Group 2 (n=26): DP consisted of DFPP and/or a ritximab, and Tac (1mg/day) and MMF (250mg /day) for one month prior to transplantation. Occurrence of acute antibody mediated rejection (AMR), graft-survival rates (GSR) and eGFR at 3 years, were compared between them. And risk factors for developing AMR in patients with DSA were evaluated. Results) 3-year AMR free ratio was 33.3% in Group 1 and 76.7% in Group 2 (p=0.0190).Figure: No Caption available.All AMRs responded to treatment consisted of DFPP, intravenous immunoglobulin, and anti-thymocyte rabbit globulin. 3-year GSR in Group 1 and 2 were 100% and 90.2%, respectively (p=0.29). However, 3-year eGFR values in patients with AMR and without AMR were 23.6±8.3 and 50.0±15.8 mL/min (p<0.001). Interestingly, 11 of 12 recipients with AMR were females (p=0.01), and 10 of them (90.1%) were donated from husband. Other factors, such as age, PRA, value of MFI of Flow Cytmetric Crossmatch test were not significant. Conclusions)In patients with DSA, there was no significant difference in graft survival between two groups, however, occurrence of AMR in Group2 was significantly lower than that of Group 1. DFPP, rituximab plus prior prescription of Tac and MMF should be a useful DP. And female recipient donated from husband was significant risk factors for graft function after LDKT in patients with DSA.