A modified perioperative regimen for deceased donor kidney transplantation in presensitized recipients without prior desensitization therapy

Frontiers in Immunology

Immunology

Rula Sa¹  Songxia Li¹  Zhiliang Guo¹  Gang Chen²  Daqiang Zhao²  Lu Wang²  Lan Zhu²  Guangyuan Zhao² 

[1] Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China;Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China;Key Laboratory of Organ Transplantation, Ministry of Education, Chinese Academy of Medical Sciences, Wuhan, China;NHC Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, China;Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, China;

关键词: kidney transplantation;    presensitization;    acute rejection;    antibody-mediated rejection;    deceased donor;   

DOI  :  10.3389/fimmu.2023.1223567

 received in 2023-05-16, accepted in 2023-06-16,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundRenal transplantation in HLA-presensitized recipients entails an increased risk of antibody-mediated rejection (AMR) and graft loss. There is currently no accepted standard treatment protocol that can help transplant surgeons safely perform deceased donor (DD) kidney transplantation in presensitized patients without pretransplant desensitization.MethodsFifty-one panel-reactive antibody (PRA)-positive recipients and 62 PRA-negative retransplant recipients (control) who received DD renal transplantation were included. Patients in the presensitized group (donor-specific antibody [DSA]-positive, n=25; DSA-negative, n=26) without desensitization received a modified perioperative treatment starting on day 0 or -1 with rituximab, thymoglobulin, and low daily doses of intravenous immunoglobulin (IVIG, 10-20 g/d, for 14 days). Plasmapheresis was performed once before surgery in DSA-positive recipients.ResultsThe median follow-up time was 51 months in the presensitized group and 41 months in the control group. The incidence of early acute rejection (AR) and AMR (including mixed rejection) was 35.3% and 13.7% in the presensitized group, respectively, significantly higher than in the control group (14.5% and 1.6%, respectively). Within the presensitized group, the DSA-positive subgroup had more AMR than the DSA-negative subgroup (24.0% vs. 3.8%), but the incidence of T cell-mediated rejection was comparable (20.0% vs. 23.4%). In the presensitized group, all rejections were successfully reversed, and graft function remained stable during follow-up. The 1-year and 3-year survival rates of the grafts and recipients in this group were 98.0%.ConclusionWith a modified IVIG-based perioperative regimen, excellent intermediate-term graft and recipient survival outcomes can be achieved in presensitized patients who received DD kidney transplantation without prior desensitization.

【 授权许可】

Unknown   
Copyright © 2023 Guo, Zhao, Sa, Wang, Li, Zhao, Zhu and Chen