Kidney transplantation of 32 patients from HLA-incompatible live donors: Efficacy and outcome after desensitization

Abstract

Desensitization is a procedure undergone by the recipient of a kidney transplant from a donor who is cross-match positive. The aim of this study was to present the outcomes from our hospital of kidney transplant recipients from HLA-incompatible live donors after desensitization.We studied 32 patients aged 46±14 years with a mean fluorescence intensity (MFI) versus class I HLA of 7979±4089 and 6825±4182 MFI versus class II and relative intensity scale (RIS) of 8.9±7.6. The complement-dependent cytotoxicity (CDC) cross-matching test was positive in 18 patients, flow cytometry was positive in 7 patients and donor-specific antibodies (DEA) were detected in 7. The protocol used was rituximab, plasmapheresis/immunoadsorption, immunoglobulins, tacrolimus, mycophenolic acid derivatives and prednisone.After 8±3 sessions of plasmapheresis/immunoadsorption, 23 patients were transplanted (71.9%) and desensitization was ineffective in 9. There were baseline differences in MFI class I (p<0.001), RIS (p=0.008), and CDC cross-matching, DSA and flow cytometry (p=0.05). MFI class I and RIS were predictors of inefficiency in ROC curves. After follow-up of 43±30 months, 13 patients (56%) presented postoperative bleeding, 3 (13%) delayed graft function, 4 (17.4%) acute rejection, 6 (26%) CMV viremia and 1 (4%) BK viremia. Five-year patient survival was 90%, with 86% allograft survival. Five-year creatinine was 1.5±0.4 and proteinuria was 0.5±0.7. ConclusionsKidney transplantation from HLA-incompatible live donors after desensitization was possible in 71.9% of patients. MFI class I and RIS predict the inefficiency of desensitization. Five-year allograft survival (86%) was acceptable with a low incidence of acute rejection (17.4%), although with a greater trend toward postoperative bleeding.