Renal transplantation in recipients with moderate presensitization


Cite item

Full Text

Abstract

Aim. To comparatively assess desensitization schemes with and without plasmapheresis in patients with low presensitization. Subjects and methods. The investigators studied the efficiency of the two desensitization schemes (cascade plasma filtration + intravenous immunoglobulin used in a dose of 100 mg/kg in 19 patients (a study group; panel reactive antibodies (PRA) 25.1±6.1%) versus 2 g/kg in 23 patients (a comparison group, PRA 18.9±4.4%). The crossmatch reaction was negative in both groups. The median follow-up period was 23.5 (quartiles 1 and 3: 10.25 and 26) months. Results. The study group was noted to have 6 episodes of acute rejection and 1 episode of infection; the comparison group had 13 and 3 episodes, respectively. The overall renal graft survival was 79 and 65% in the study and comparison groups, respectively; the 1-year graft survival was 94 and 62%. Graft function was significantly better in the study group: there was a lower daily proteinuria level (p<0.001) at 3 months after transplantation; a higher glomerular filtration rate (GFR) (p=0.001) and a lower daily proteinuria level (p=0.01) at 6 months; a lower serum creatinine comcentration (p=0.001) and lower daily proteinuria (p=0.001) and a higher GFR (p=0.001) at one year. Conclusion. Even with the relatively low level of sensitization, there is an increase in the frequency of acute rejection episodes and worse graft function. The efficiency of desensitization using cascade plasma filtration and low-dose intravenous immunoglobulin is higher than that with high-dose intravenous immunoglobulin.

About the authors

A V Vatazin

Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского

Москва, Россия

A B Zulkarnaev

Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского

Москва, Россия

References

  1. Готье С.В., Мойсюк Я.Г., Хомяков С.М. Донорство и трансплантация органов в российской федерации в 2014 году VII сообщение регистра Российского трансплантологического общества. Вестник трансплантологии и искусственных органов. 2015;17(2):7-22 doi: 10.15825/1995-1191-2015-2-7-22.
  2. Stel VS, Kramar R, Leivestad T, Hoitsma AJ, Metcalfe W, Smits JM, Ravani P, Jager KJ. Time trend in access to the waiting list and renal transplantation: a comparison of four European countries. Nephrol Dial Transplant. 2012;27(9):3621-31. doi: 10.1093/ndt/gfs089.
  3. Matas AJ, Smith JM, Skeans MA, Thompson B, Gustafson SK, Stewart DE, Cherikh WS, Wainright JL, Boyle G, Snyder JJ, Israni AK, Kasiske BL. OPTN/SRTR 2013 Annual Data Report: kidney. Am J Transplant. 2015;15(Suppl 2):1-34. doi: 10.1111/ajt.13195.
  4. Lim WH, Chapman JR, Wong G. Peak panel reactive antibody, cancer, graft, and patient outcomes in kidney transplant recipients. Transplantation. 2015;99(5):1043-1050. doi: 10.1097/TP.0000000000000469.
  5. Бикбов Б.Т., Томилина Н.А. Заместительная терапия больных с хронической почечной недостаточностью методами перитонеального диализа и трансплантации почки в российской федерации в 1998—2011 г. (Отчет по данным российского регистра заместительной почечной терапии. Часть вторая). Нефрология и диализ. 2014;16(2):192-227.
  6. Al-Jedai A, Alsultan M, Almeshari K, Alshaibani K, Elgamal H, Alkortas D, Khurshid F, Altalhi M, Hamawi K. Cost analysis of kidney transplantation in highly sensitized recipients compared to intermittent maintenance hemodialysis. Ann Transplant. 2012; 17(4):82-91.
  7. Wang D, Wu WZ, Yang SL, Chen JH, Tan JM. Preoperative single-bolus high-dose antithymocyte globulin as induction therapy in sensitized renal transplant recipients. Chin Med J (Engl). 2006;119(20):1683-1688.
  8. Lü TM, Yang SL, Wu WZ, Tan JM. Alemtuzumab induction therapy in highly sensitized kidney transplant recipients. Chin Med J (Engl). 2011;124(5):664-668.
  9. Yin H, Wan H, Hu XP, Li XB, Wang W, Liu H, Ren L, Zhang XD. Rituximab induction therapy in highly sensitized kidney transplant recipients. Chin Med J (Engl). 2011;124(13):1928-1932.
  10. Jordan SC, Choi J, Vo A. Kidney transplantation in highly sensitized patients. Br Med Bull. 2015;114(1):113-125. doi: 10.1093/bmb/ldv013.
  11. Wongsaroj P, Kahwaji J, Vo A, Jordan SC. Modern approaches to incompatible kidney transplantation. World J Nephrol. 2015;4(3): 354-362. doi: 10.5527/wjn.v4.i3.354.
  12. Picascia A, Grimaldi V, Paolillo R, Vasco M, Casamassimi A, De Luca FP, Cavalca F, Schiano C, Napoli C. Intravenous human immunoglobulin treatment of serum from HLA-sensitized patients in kidney transplantation. Ren Fail. 2014;36(4):585-588. doi: 10.3109/0886022X.2014.880326.
  13. Jin MK, Cho JH, Kwon O, Hong KD, Choi JY, Yoon SH, Park SH, Kim YL, Kim CD. Successful kidney transplantation after desensitization using plasmapheresis, low-dose intravenous immunoglobulin, and rituximab in highly sensitized patients: a single-center experience. Transplant Proc. 2012;44(1):200-203. doi: 10.1016/j.transproceed.2011.11.040.
  14. Pretagostini R, Poli L, Gozzer M, Pettorini L, Garofalo M, Novelli S, Cinti P, Berloco PB. Plasmapheresis, Photopheresis, and Endovenous Immunoglobulin in Acute Antibody-mediated Rejection in Kidney Transplantation. Transplant Proc. 2015;47(7): 2142-2144. doi: 10.1016/j.transproceed.2015.01.030.
  15. Gungor O, Sen S, Kircelli F, Yilmaz M, Sarsik B, Ozkahya M, Hoscoskun C, Ok E, Toz H. Plasmapheresis therapy in renal transplant patients: five-year experience. Transplant Proc. 2011; 43(3):853-857. doi: 10.1016/j.transproceed.2011.03.025.
  16. Каабак М.М., Горяйнов В.А., Зокоев А.К., Бабенко Н.Н., Рагимов А.А., Салимов Э.Л., Соловьева И.Н., Алексеева Л.А., Морозова М.М., Шишло Л.А. Десятилетний опыт применения раннего плазмафереза после пересадки почки. Вестник трансплантологии и искусственных органов. 2009;11(1):28-33.

Copyright (c) 2016 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
 
 


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies