Renal Transplantation in Donor Specifi c Antibody Positive Sensitized Patients: Single Center Experience

In recent years, there are increasing number of sensitized patients waiting for renal transplantation (RTx) who are donor specifi c antibody (DSA) positive and lymphocyte crossmatch (LCM) negative. In this study, we present our transplantation experience in patients with LCM (-) and DSA (+).

We enrolled 4 LCM (-) and panel reactive antibody (PRA) screening positive patients who had a living kidney donor. We evaluated antibodies to determine whether they were DSA or not. If they were DSA, we included these patients in our protocol (DSA level: mean fl uorescein intensity >1000). Two had previous RTx. In our protocol, we started MMF (2gr/day), tacrolimus 0.01 mg/kg, and prednisolone 0.5 mg/kg on day -6. We performed 2 sessions of plasmapheresis (PP) and gave 2 doses of 5 gr/day IVIG. On day -1, 200 mg rituximab was given. On the operation day, the patients received basiliximab. Serum samples were taken on days -6, 0, and 30.

All patients had immediate graft function after RTx. Two patients had acute rejection (AR). Average follow up was 4 months and creatinine levels are 0.7-1.3 mg/dl.

In conclusion, RTx can be succesfully performed in sensitized patients with DSA. However, there seems to be higher acute rejection risk in these patients.