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Management of highly sensitized patients: capitol medical center experience

A J Amante1, R Ejercito

  • 1Capitol Medical Center, Quezon City, Philippines.

Transplantation Proceedings
|September 16, 2008
PubMed

Insights

Highly sensitized patients can now receive kidney transplants. A desensitization protocol using Rituximab, IVIG, and plasmapheresis effectively prepared patients with anti-HLA antibodies for successful transplantation.

Area of Science:

  • Nephrology
  • Immunology
  • Transplantation

Background:

  • Highly sensitized patients with anti-HLA antibodies face challenges in kidney transplantation due to cross-match positivity.
  • Longer waiting times for cadaveric donors are common for these patients.
  • Existing strategies aim to overcome cross-match positivity for successful transplantation.

Purpose of the Study:

  • To evaluate the efficacy of a desensitization protocol in preparing highly sensitized patients for kidney transplantation.
  • To report clinical experience with Rituximab-based desensitization combined with IVIG and/or plasmapheresis.

Main Methods:

  • A desensitization protocol was employed.
  • The protocol included the monoclonal antibody Rituximab.
  • Intravenous immunoglobulin (IVIG) and/or plasmapheresis were used as complementary treatments.

Main Results:

  • The desensitization protocol successfully prepared highly sensitized patients for kidney transplantation.
  • The combination of Rituximab with IVIG and/or plasmapheresis addressed cross-match positivity.
  • Successful kidney transplantation was achieved in these challenging cases.

Conclusions:

  • Desensitization protocols, particularly those involving Rituximab, are effective in enabling kidney transplantation for highly sensitized patients.
  • This approach overcomes barriers posed by anti-HLA antibodies and cross-match positivity.
  • The study highlights a viable strategy to improve transplant access for patients with high immunological risk.

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