Hyperimmunized patients awaiting cadaveric kidney graft: is there a quick desensitization possible?

Area of Science:

• Nephrology
• Immunology
• Transplantation

Background:

• Patients with high panel reactive antibody (PRA >80%) face significant challenges in kidney transplantation.
• Finding compatible donors with negative crossmatch tests (CMX) is difficult for highly sensitized individuals.

Purpose of the Study:

• To explore rapid desensitization protocols for kidney transplant candidates with high PRA.
• To evaluate the efficacy of plasmapheresis (PP) + low-dose intravenous immunoglobulin (IVIG) in converting positive CMX to negative.

Main Methods:

• Review of a case involving combined liver-kidney transplant where CMX converted post-liver operation.
• Proposal of a rapid desensitization protocol using PP + low-dose IVIG for selected high-PRA patients.
• Analysis of outcomes for patients with low-titer PRA undergoing this protocol.

Main Results:

• A combined liver-kidney transplant demonstrated CMX conversion within 8 hours, leading to a successful kidney transplant lasting over 3 years.
• The proposed rapid desensitization protocol offers a potential solution for patients with high, but not strong, immunization.
• This approach may convert positive CMX to negative, enabling transplantation with reduced immunosuppression risks.

Conclusions:

• Rapid desensitization protocols, such as PP + low-dose IVIG, show promise for improving transplant outcomes in highly sensitized kidney patients.
• This strategy allows for timely transplantation by converting positive CMX to negative, with immunosuppression initiated only when a kidney is available.
• Selected patients with high PRA may benefit from this accelerated approach, minimizing risks associated with prolonged desensitization.