Overcoming a Positive Crossmatch in Living-Donor Kidney Transplantation |
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Authors: | James M. Gloor Steven R. DeGoey Alvaro A. Pineda S. Breanndan Moore Mikel Prieto Scott L. Nyberg Timothy S. Larson Matthew D. Griffin Stephen C. Textor Jorge A. Velosa Thomas R. Schwab Lynette A. Fix Mark D. Stegall |
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Affiliation: | Department of Medicine, Division of Nephrology, Mayo Foundation and Clinic, 200 First St SW, Rochester, MN 55905, USA. |
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Abstract: | Many patients who have an otherwise acceptable living-kidney donor do not undergo transplantation because of the presence of antibodies against the donor cells resulting in a positive crossmatch. In the current study, 14 patients with a positive cytotoxic crossmatch (titer = 1 : 16) against their living donor underwent a regimen including pretransplant plasmapheresis, intravenous immunoglobulin, rituximab and splenectomy. Eleven of 14 grafts (79%) are functioning well 30-600 days after transplantation. Two grafts were lost to accelerated vasculopathy and one was lost to death with good function. No hyperacute or cellular rejections occurred. Antibody-mediated rejection occurred in six patients [two clinical (14%) and four subclinical (29%)] and was reversible with plasmapheresis and steroids. Our results suggest that selected crossmatch-positive patients can be transplanted successfully with living-donor kidney allografts, using a protocol of pretransplant plasmapheresis, intravenous immunoglobulin, rituximab and splenectomy. Longer follow-up will be needed, but the absence of anti-donor antibody and good early outcomes are encouraging. |
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Keywords: | Alloantibody intravenous immunoglobulin kidney transplantation plasmapheresis positive crossmatch sensitized patient |
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