Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation · 2026
A Tale of Two Strategies: Desensitization and Donor-Specific Antibody-Free Transplant in Highly Sensitized Patients.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Nafar Mohsen, Poorrezagholi Fatemeh, Chimeh Mahsa Hosseini, Samavat Shiva, Moghaddam Marieh Farrokhy, Samadian Fariba, Firuzan Ahmad, Dalili Nooshin, Tehranfar Amirreza Laripour, Ameri Sahand
Аннотация
OBJECTIVES: Human leukocyte antigen incompatibility, particularly in broadly sensitized kidney transplant candidates with high calculated panel reactive antibody, poses a significant barrier to transplantation. Two strategies exist: (1 ) virtual crossmatch with a donor -specific antibody -free donor or (2 ) desensitization. We compared immunological risks and posttransplant complications between these 2 approaches.
MATERIALS AND METHODS: We retrospectively screened 50 kidney transplant candidates with calculated panel reactive antibody ≥95 %. Donor -specific antibody positivity was defined as mean fluorescence intensity >750. Of 25 participants (13 male; mean age 36.8 ± 14.3 years ), 12 had calculated panel reactive antibody ≥95 % and no donor -specific antibodies (group A ), whereas 13 showed positivity for donor -specific antibodies and underwent desensitization (plasmapheresis, intravenous immunoglobulin, and rituximab with or without bortezomib; group B ). All but 1 patient received living donor transplants. Sensitization included prior transplant (n = 22 ), transfusions (n = 23 ), and pregnancies (n = 7 ).
RESULTS: Median follow -up was 18 months, with no significant difference in estimated glomerular filtration rate between groups at any time point (at day of discharge; at 1, 3, 6, 12, 18, and 24 months posttransplant, and at most recent follow -up ). One graft loss occurred in group A due to vascular complications at 5 months. Sixteen biopsies were performed. Four episodes of acute antibody -mediated rejection were observed (1 in group A, 3 in group B; P = .728 ). Posttransplant infections occurred in 7 patients (28 % ), all in group B (P = .005 ), including BK virus (n = 5; P = .039 ) and parvovirus B19 (n = 2 ). Four patients in group A remained on immunosuppression versus none in group B (P = .039 ).
CONCLUSIONS: In highly sensitized kidney transplant recipients, both virtual crossmatch with donor -specific antibody -free donors and desensitization strategies resulted in comparable short -term graft function. However, desensitized patients showed significantly higher risk of posttransplant infections.
MATERIALS AND METHODS: We retrospectively screened 50 kidney transplant candidates with calculated panel reactive antibody ≥95 %. Donor -specific antibody positivity was defined as mean fluorescence intensity >750. Of 25 participants (13 male; mean age 36.8 ± 14.3 years ), 12 had calculated panel reactive antibody ≥95 % and no donor -specific antibodies (group A ), whereas 13 showed positivity for donor -specific antibodies and underwent desensitization (plasmapheresis, intravenous immunoglobulin, and rituximab with or without bortezomib; group B ). All but 1 patient received living donor transplants. Sensitization included prior transplant (n = 22 ), transfusions (n = 23 ), and pregnancies (n = 7 ).
RESULTS: Median follow -up was 18 months, with no significant difference in estimated glomerular filtration rate between groups at any time point (at day of discharge; at 1, 3, 6, 12, 18, and 24 months posttransplant, and at most recent follow -up ). One graft loss occurred in group A due to vascular complications at 5 months. Sixteen biopsies were performed. Four episodes of acute antibody -mediated rejection were observed (1 in group A, 3 in group B; P = .728 ). Posttransplant infections occurred in 7 patients (28 % ), all in group B (P = .005 ), including BK virus (n = 5; P = .039 ) and parvovirus B19 (n = 2 ). Four patients in group A remained on immunosuppression versus none in group B (P = .039 ).
CONCLUSIONS: In highly sensitized kidney transplant recipients, both virtual crossmatch with donor -specific antibody -free donors and desensitization strategies resulted in comparable short -term graft function. However, desensitized patients showed significantly higher risk of posttransplant infections.
Предметные рубрики MeSH
HumansKidney TransplantationFemaleDesensitization, ImmunologicTreatment OutcomeAdultHistocompatibilityHLA AntigensRetrospective StudiesIsoantibodiesMaleRisk FactorsTime FactorsGraft SurvivalMiddle AgedGraft RejectionHistocompatibility TestingPlasmapheresisImmunosuppressive AgentsYoung AdultImmunoglobulins, IntravenousRituximabBortezomibBiomarkers