Desensitizing the broadly human leukocyte antigen-sensitized patient awaiting deceased donor kidney transplantation |
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Authors: | Jordan S C Reinsmoen N Lai C-H Cao K Kahwaji J Peng A Villicana R Vo A |
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Affiliation: | a Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, California, USA b HLA Laboratory, Cedars-Sinai Medical Center, Los Angeles, California, USA |
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Abstract: | For broadly human leukocyte antigen-sensitized patients (HS; calculated panel-reactive antibody >80%), options for deceased donor (DD) transplantation are extremely limited. Data from United Network for Organ Sharing (2000-2009) indicate that <10% of HS patients are transplanted each year. Immune modulation of HS patients using intravenous immunoglobulin (IVIG) and rituximab has shown promise in reducing donor-specific antibody (DSA) titers and improving the chances for successful transplantation for patients awaiting DD transplants. Critical to the success of desensitization with IVIG + rituximab is a coherent antibody-testing strategy aimed at detection of DSA reductions and identification of crossmatch parameters that are associated with a low likelihood of antibody-mediated rejection posttransplant. Here, we discuss data that examine the efficacy of IVIG + rituximab in reducing DSA levels and improving chances for a successful DD transplantation. Patient and graft survival data are also presented as is an analysis of the safety of IVIG + rituximab in sensitized patients. |
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