Abstract
Aim To assess outcomes of desensitization in the management of immunological hurdles in renal transplantation program and to share our experience with peer groups. Methods Since 2010 we established a desensitization program at our hospital using therapeutic plasma exchange (TPE). We performed TPE in cases when DSA-HLA titer > 5000 MFI. 1.5 of patient’s total plasma were removed every other day and replaced with albumin 5%, the procedure was continued to a level below 2000 MFI. TPE procedure is followed immediately or within maximum of 2 hours by infusion of IVIG or anti-thymocyte globulin. The standard immunosuppressive protocol at our transplant Centre, Induction: Basiliximab and Methylprednisolon; Maintenance: Mycophenolate mofetil, Prednisone and Tacrolimus. Single antigen beads based assay was used to determine the level of DSA in recipients’ serum. Complement fixing HLA-Ab detected by C1q assay provided by one lambda. Flow HLA-cross match performed routinely, while CDC cross match performed only in selective cases. Cutoff off 1000 MFI point out positive result for DSA and 30 MSC and 21 MSC for B and T cell cross match respectively. Results About 8% of all live kidney transplants (N = 31/428) were carried out successfully through HLA-antibodies without any signs of rejection. In two cases, negative C1q results were observed with an immediately function of transplanted kidney, despite high DSA titer of MFI > 10,000. One of these two cases was in flow cross positive for both T (+209 MCS) and B (+224 MCS) cell IgG, the other one with negative cross match. Conclusions Using desensitization and therapeutic concept of TPE, organ rejection can be avoided in selected cases of ABO and HLA-incompatibility. However, the interpretation of DSA and flow cross match was more accurate and predictive when the antibody results of C1q assay were considered along with the high resolution HLA typing.
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