46-P: RENAL TRANSPLANTATION IN THE PRESENCE OF ANTI-HLA ANTIBODIES

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• 作者：Dave Roelen¹ ; Ajda Rowshani² ; Simone Brand-Schaaf¹ ; Jacqueline vd Wetering² ; Joke Roodnat² ; Sophia Stein¹ ; Willem Weimar² ; Frans Claas¹
• 刊名：Human Immunology
• 出版年：2012
• 出版时间：October, 2012
• 年：2012
• 卷：73
• 期：supp_S
• 页码：78
• 全文大小：30 K

文摘

Aim

Until recently, living donor kidney transplantation was not performed in case of a positive crossmatch due to the presence of donor specific HLA antibodies in historical serum. Furthermore, patients with anti-donor HLA antibodies present in current sera as detected by Luminex-based solid-phase assays will often not be transplanted with such a donor without desensitization.

Methods

Between February 2010 and July 2011, 6 immunized renal transplant candidates with a positive crossmatch against their living donor, were transplanted without any desensitization. These patients received standard immunosuppressive therapy, which consisted of a combination of tacrolimus, mycophenolate, corticosteroids, and basiliximab.

Results

In 5 patients (CDC reactive) antibodies were found against the HLA mismatch of their living donor in historical sera. Current en historical panel reactive antibody level of these patients were respectively: cur 4 % his 82 % , cur 0 % his 100 % , cur 0 % his 96 % , cur 4 % his 65 % and cur 0 % his 94 % . The HLA mismatches were HLA-A1, -A2 (2x), -A3 and HLA-DR3. In 4 of the 5 patients this HLA mismatch was a repeated mismatch. In 2 of the 5 patients with historical CDC reactive antibodies against the repeated mismatch the Luminex assays in current sera was (weakly) positive. In a 6th patient, the current serum was strongly positive in the Luminex assay for the HLA-DR9 mismatch (PRA cur 33 % his 56 % ). Three of these 6 patients experienced a rejection but until now (follow up: 7-20 months) all these transplants are functioning well.

Conclusions

Our conclusion is that a positive CDC crossmatch in historical sera is not a contra-indication for kidney transplantation not even in the presence of donor specific antibodies detected in current serum by Luminex-based solid-phase assays.