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BIBTEX RIS

Desensitization using IVIG alone for living-donor kidney transplant: impact on donor-specific antibodies

2022; Sociedade Brasileira de Nefrologia; Volume: 44; Issue: 4 Linguagem: Inglês

10.1590/2175-8239-jbn-2021-0200

ISSN

2175-8239

Autores

Luiz Roberto de Sousa Ulisses, Jenaine Oliveira Paixão, Fabiana Agena, Patrícia Soares de Souza, Flávio Jota de Paula, Gislene Bezerra, H. Rodrigues, Nicolas Panajotopolous, Elias David‐Neto, Maria Cristina Ribeiro de Castro,

Tópico(s)

Immunodeficiency and Autoimmune Disorders

Resumo

Sensitization to human leukocyte antigen is a barrier to. Few data have been published on desensitization using polyvalent human intravenous immunoglobulin (IVIG) alone.We retrospectively reviewed the of 45 patients with a positive complement-dependent cytotoxicity crossmatch (CDCXM) or flow cytometry crossmatch (FCXM) against living donors from January 2003 to December 2014. Of these, 12 were excluded. Patients received monthly IVIG infusions (2 g/kg) only until they had a negative T-cell and B-cell FCXM.During the 33 patients, 22 (66.7%) underwent living donor kidney transplantation, 7 (21.2%) received a deceased donor graft, and 4 (12.1%) did not undergo transplantation. The median class I and II panel reactive antibodies for these patients were 80.5% (range 61%-95%) and 83.0% (range 42%-94%), respectively. Patients (81.8%) had a positive T-cell and/or B-cell CDCXM and 4 (18.2%) had a positive T-cell and/or B-cell FCXM. Patients underwent transplantation after a median of 6 (range 3-16). The median donor-specific antibody mean fluorescence intensity sum was 5057 (range 2246-11,691) before and 1389 (range 934-2492) after desensitization (p = 0.0001). Mean patient follow-up time after transplantation was 60.5 (SD, 36.8) months. Nine patients (45.0%). Death-censored graft survival at 1, 3, and 5 years after transplant was 86.4, 86.4, and 79.2%, respectively and patient survival was 95.5, 95.5, and 83.7%, respectively.Desensitization using IVIG alone is an effective strategy, allowing successful transplantation in 87.9% of these highly sensitized patients.

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